This evidence-based series was developed by the Gynecology Cancer Disease Site Group (DSG) of Cancer Care Ontario's Program in Evidence-Based Care (PEBC). The series is a convenient and up-to-date source of the best available evidence on chemotherapy for recurrent, metastatic, or persistent cervical cancer, developed through systematic review, evidence synthesis, and input from practitioners in Ontario.
Fifteen randomized trials reported outcomes for chemotherapeutic regimens for the treatment of patients with recurrent, metastatic, or persistent cervical cancer. Seven of those trials compared single-agent cisplatin to combination cisplatin-based chemotherapy. Of the remaining trials, two compared combination-agent cisplatin with another chemotherapeutic regimen, three trials compared regimens of other platinum-containing agents, and three trials compared regimens of non-platinum-containing agents.
The methodological quality of the studies was deemed to be adequate for the purpose of deriving conclusions around the chemotherapeutic treatment of patients with recurrent, metastatic, or persistent cervical cancer. Changes in practice over time (i.e., the emergence of the use of radiosensitizers), the limited number of patients available to participate in the trials, and limitations in study design, such as a lack of blinding, contributed to this analysis of quality. Although three trials were stopped early, discontinuation was due to poor patient accrual and the termination of support. However, all of the trials were randomized, baseline characteristics were well balanced between treatment groups, and the power to detect statistically significant differences between treatment groups was reported in a number of trials, as was the intention-to-treat principle.
See the original guideline document for a discussion of the evidence used to formulate the recommendations.