背景:复发性高级别宫颈神经内分泌癌的预后非常差,积极的治疗选择有限。
目的:评价托泊替康三药方案的疗效,紫杉醇,和贝伐单抗(TPB)治疗复发性高级别宫颈神经内分泌癌的女性。
方法:这项回顾性队列研究使用了神经内分泌宫颈肿瘤登记处(NeCTuR)的数据,其中包括直接从来自英语和西班牙语国家的被诊断患有高级别宫颈神经内分泌癌的妇女的医疗记录中提取的数据。该研究比较了接受TPB作为一线或二线治疗的复发性高级别宫颈神经内分泌癌的女性和接受化疗但未接受TPB的复发性高级别宫颈神经内分泌癌的女性。患者持续化疗直至疾病进展或出现不可接受的毒性作用。从复发治疗开始到下一次复发或死亡的无进展生存期,首次复发的总生存率,和反应率进行了评估。
结果:该研究包括62例接受TPB作为一线或二线治疗复发的患者和56例接受化疗但未接受TPB治疗复发的患者。TPB组的中位无进展生存期为8.7个月,而非TPB组的中位无进展生存期为3.7个月。进展的风险比为0.27(95%CI0.17-0.48;P<0.0001)。在TPB组中,15%的人病情稳定,39%有部分反应,18%的人有完整的反应。在6个月时,TPB组的患者明显多于非TPB组(67%vs.31%,P=0.0004)和1年(24%与9%,P=0.02)。TPB组的中位总生存期为16.8个月,而非TPB组为14.0个月,死亡风险比为0.87(95%CI0.55-1.37)。
结论:TPB是复发性高级别宫颈神经内分泌癌女性的积极治疗方案,可改善无进展生存期,同时降低进展风险比。
Recurrent high-grade neuroendocrine cervical cancer has a very poor prognosis and limited active treatment options.
This study aimed to evaluate the efficacy of the 3-drug regimen of topotecan, paclitaxel, and bevacizumab in women with recurrent high-grade neuroendocrine cervical cancer.
This retrospective cohort study used data from the Neuroendocrine Cervical Tumor Registry (NeCTuR), which include data abstracted directly from medical records of women diagnosed with high-grade neuroendocrine carcinoma of the cervix from English- and Spanish-speaking countries. The study compared women with recurrent high-grade neuroendocrine cervical cancer who received the topotecan, paclitaxel, and bevacizumab regimen as first- or second-line therapy for recurrence and women with recurrent high-grade neuroendocrine cervical cancer who received chemotherapy but not the topotecan, paclitaxel, and bevacizumab regimen. Patients continued chemotherapy until disease progression or the development of unacceptable toxic effects. Progression-free survival from the start of therapy for recurrence to the next recurrence or death, overall survival from the first recurrence, and response rates were evaluated.
The study included 62 patients who received the topotecan, paclitaxel, and bevacizumab regimen as first- or second-line therapy for recurrence and 56 patients who received chemotherapy but not the topotecan, paclitaxel, and bevacizumab regimen for recurrence. The median progression-free survival rates were 8.7 months in the topotecan, paclitaxel, and bevacizumab regimen group and 3.7 months in the non-topotecan, paclitaxel, and bevacizumab regimen group, with a hazard ratio for disease progression of 0.27 (95% confidence interval, 0.17-0.48; P<.0001). In the topotecan, paclitaxel, and bevacizumab regimen group, 15% of patients had stable disease, 39% of patients had a partial response, and 18% of patients had a complete response. Compared with patients in the non-topotecan, paclitaxel, and bevacizumab regimen group, significantly more patients in the topotecan, paclitaxel, and bevacizumab regimen group remained on treatment at 6 months (31% vs 67%, respectively; P=.0004) and 1 year (9% vs 24%, respectively; P=.02). The median overall survival rates were 16.8 months in the topotecan, paclitaxel, and bevacizumab regimen group and 14.0 months in the non-topotecan, paclitaxel, and bevacizumab regimen group, with a hazard ratio for death of 0.87 (95% confidence interval, 0.55-1.37).
Combination therapy with topotecan, paclitaxel, and bevacizumab was an active regimen in women with recurrent high-grade neuroendocrine cervical cancer and improved progression-free survival while decreasing the hazard ratio for disease progression.