Cervical Cancer

Multiple Choice Questions

1. Cisplatin–gemcitabine
   
2. Cisplatin–paclitaxel
   
3. Cisplatin–topotecan
   
4. None of the above

A phase III randomized trial conducted in South America has revealed the superiority of the combination of cisplatin plus gemcitabine compared to cisplatin alone when employed as a component of a concurrent chemoradiation strategy. Despite this outcome, this strategy has not been adopted for routine use as several groups have found excessive toxicity associated with this chemotherapy combination when added to external-beam radiation.

1. A higher-than-expected percentage of patients in the cisplatin-only arm being more than 65 years of age
   
2. A higher-than-expected percentage of patients in the combination chemotherapy arm who had not previously received external-beam radiation
   
3. A higher than expected percentage of patients in both study arms who were HIV-positive
   
4. A large percentage of patients had previously received cisplatin as a component of a chemoradiation program

While this is not the fault of the study investigators, the relevance of this study has been questioned because a substantial proportion of individuals entered into the trial had previously received (and failed) a cisplatin-containing chemoradiation program. Thus, one rational interpretation of this study is that it actually compared “single agent topotecan” to “no chemotherapy” rather than defining the activity of this combination cisplatin-based regimen.

1. Cisplatin–paclitaxel
   
2. Cisplatin–gemcitabine
   
3. Cisplatin–topotecan
   
4. None of the above

In this landmark Gynecologic Oncology Group study, there was no statistically significant difference in either time to disease progression or overall survival in any of the study arms (cisplatin–paclitaxel, cisplatin–gemcitabine, cisplatin–topotecan, or cisplatin–gemcitabine).

1. Prior documented human papilloma virus (HPV) infection
   
2. Prior chemoradiation
   
3. Disease in a previously radiated region
   
4. None of the above

Both prior chemoradiation and disease in a previously radiated area will negatively impact the opportunity for a response to platinum-based systemic therapy for metastatic or recurrent cervical cancer.

1. Erlotinib
   
2. Venurafinib
   
3. Bevacizumab
   
4. Gefitinib

In a report of a phase III randomized trial, the addition of bevacizumab to combination chemotherapy was shown to result in a statistically significant improvement in overall survival in metastatic and recurrent cervical cancer. This was the first randomized trial to document the utility of a noncytotoxic agent in this clinical setting.