NOVEL TREATMENTS OF CERVICAL-CANCER

Cervical cancer is a leading cause of mortality among women in develop ing countries. Surgical and radiation therapy have been the standards of care. However, with advanced stages of disease these modalities are decreasingly useful. Investigational therapies involving the concurre nt use of chemotherapy with radiation therapy have not demonstrated im proved long-term survival in randomized studies. New chemotherapy agen ts, including the taxanes paclitaxel (Taxol(R)) and docetaxel and topo isomerase-I inhibitors like irinotecan (CPT-11), demonstrate activity in this disease. The neoangiogenesis inhibitor TNP-470 has also shown signs of clinical activity. Because of the association of papillomavir us with cervical cancer, vaccine strategies have been explored. The va ccine approach has been most successful in animal models. Human vaccin e trials are ongoing. Problems facing the latter include limitations o f immunogen and identification of appropriate patient subgroups. Biolo gic therapy has focused on cis-retinoic acid and interferon-alpha comb inations. Although active in untreated patients, the activity in patie nts with prior radiotherapy or chemotherapy is modest. Trials combinin g radiation therapy with cis-retinoic acid and interferon-alpha are on going. The investigational treatments of cervical cancer have focused on combination chemoradiation therapy, new chemotherapy drug developme nt, and biologic agents. With increased understanding of papillomaviru s, vaccine approaches will be given a higher priority.