Paclitaxel, ifosfamide and cisplatin (TIP) chemotherapy for recurrent or persistent squamous-cell cervical cancer

Purpose: The results of salvage chemotherapy for recurrent or persistent sq uamous-cell cervical cancer are unsatisfactory. Cisplatin and Ifosfamide ar e effective compounds in cervical cancer. Paclitaxel has recently been test ed with promising results. The aim of this study was to assess the efficacy of a combination of paclitaxel, ifosfamide and cisplatin (TIP) for persist ent/recurrent squamous-cell cervical carcinoma in a phase II trial. Patients and methods: Forty-five women were treated with the TIP regimen. T hirty-one had received prior irradiation. Paclitaxel was given at a dose of 175 mg/m(2), ifosfamide at a dose of 5 g/m(2), and cisplatin at a dose of 75 mg/m(2) (50 mg/m(2) in irradiated patients) at three-week intervals. Results: We observed 15 clinical complete responses, 15 partial responses, 9 stable diseases and 6 progressions. The objective response rate was 67% ( 95% confidence interval: 51%-81%). Ten complete responders underwent subseq uent surgery and seven had pathology-defined complete responses (two in irr adiated areas). The response rate was 52% in irradiated and 75% in non-irra diated areas. The median survival for non-responders is 6 months, 9+ month for partial re sponders and 13+ for complete responders. The most relevant side effect was myelotoxicity, with 91% of patients experiencing grade 3-4. One woman had life-threatening toxic effects. Conclusions: This combination is highly effective for salvage treatment in non-irradiated patients. For irradiated women the response rate is higher t han that observed with other regimens but further investigation is warrante d. The toxicity is relevant but adequate hydration and prolonged infusion o f ifosfamide make it acceptable.