Advances in paclitaxel combinations for treating cervical cancer

ABSTRACT

Introduction

Cervical cancer is the fourth common cancer in women worldwide. While, in the past, locally advanced stage disease was treated by pelvic radiotherapy, nowadays the National Cancer Institute strongly recommends chemoradiation protocols. Weekly cisplatin was previously the standard of care in this setting; however, the low response rate and the short median progression-free survival (PFS) of patients have led researchers to investigate combinatory regimens.

Area covered

This article is based on literature searches up until April 2019, with current trial registers also analyzed. All data available on this topic has been summarized in this narrative review.

Expert opinion

In recent years, it has been demonstrated that cisplatin-based doublets, and in particular, cisplatin plus paclitaxel, are superior to cisplatin as a monotherapy in terms of response rate and progression-free survival of patients with advanced cervical cancer. This double regime combined with bevacizumab is also considered the first-line option for metastatic or recurrent disease. Dose-dense paclitaxel in neo-adjuvant chemotherapy combinations is a promising option in patients with locally advanced cervical cancer. Exploration of novel biological therapies and in vitro combinations based on the use of paclitaxel is warranted.

KEYWORDS:

• Cervical Cancer
• investigational drugs
• paclitaxel
• chemotherapy
• cytotoxic regimens
• quality of life

Article highlights

• The National Cancer Institute (NCI) strongly recommends chemoradiation protocols instead of pelvic radiotherapy alone for locally advanced stage cervical cancer (FIGO Ib2–IVa).

• The platinum/paclitaxel combination tends to be the preferred regimen in terms of response rate (RR) and progression-free survival (PFS) in patients with locally advanced cervical cancer (FIGO Ib2–IVa).

• Dose-dense paclitaxel within neo-adjuvant chemotherapy combinations is feasible and effective for treating patients with locally advanced cervical cancer (FIGO Ib2–IVa).

• The doublet paclitaxel-cisplatin combined with bevacizumab is considered the preferred first-line regimen against metastatic, persistent and recurrent cervical cancer (FIGO IVb).

• Nab-paclitaxel (Albumin-Bound Paclitaxel) has proven activity and moderate toxicity in the treatment of drug-resistant, metastatic and recurrent cervical cancer.

• CDK (serine/threonine cyclin-dependent kinases) inhibitors are an innovative class of drugs; they could be an experimental approach enhancing the therapeutic efficacy of paclitaxel in advanced cervical cancer as well as to overcome the resistance to this cytotoxic drug.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript is not funded.