ABSTRACT
OPINION STATEMENT: Gynecologic cancer patients frequently desire alternative and/or complementary interventions or medicines to aid in relief of both cancer-related and treatment-related side effects. Furthermore, women also seek treatment to aid in superior outcomes and cure rates. Unfortunately, evidence suggests that the use of complementary and/or alternative medicine (CAM) is underreported or not discussed with physicians providing cancer care. In gynecologic cancer literature, there is a lack of scientific evidence either supporting or negating CAM. Because of the lack of information available, health care providers do not have good information regarding safety, efficacy, and dose of CAM. This leads to miscommunication or absence of communication between providers and patients. Because patients do use CAM to improve quality of life (QOL) during and after treatment, it would be educational for providers to know the specific QOL deficits among patients that require attention. Thus, with the ultimate goal of improving QOL for gynecologic cancer patients, providers should be pushed to investigate CAM and determine an honest support or rejection of these therapies.
Subject(s)
Complementary Therapies , Genital Neoplasms, Female/therapy , Female , HumansABSTRACT
Though cervical cancer incidence and prevalence have decreased in the United States, the disease remains a very important cause of morbidity and mortality worldwide. Current therapy for early-stage disease is surgical with adjuvant therapy being administered according to histopathologic findings. Pelvic radiation with concomitant platinum-based chemotherapy is used to treat locally advanced disease, whereas metastatic and recurrent lesions continue to be difficult to effectively treat and cure. Clinical trials in this latter scenario have suggested that clinical benefit may be associated with biologic therapies. This article focuses on the use of targeted therapies in cervical cancer, specifically evaluating antiangiogenesis and endothelial growth factor receptor-related treatments.
Subject(s)
Biological Products/therapeutic use , Uterine Cervical Neoplasms/therapy , Clinical Trials, Phase II as Topic , Female , Humans , Molecular Targeted Therapy , Neovascularization, Pathologic/diagnosis , Neovascularization, Pathologic/metabolism , Receptors, Vascular Endothelial Growth Factor/antagonists & inhibitors , Vascular Endothelial Growth Factors/antagonists & inhibitorsABSTRACT
While the incidence of cervical cancer has declined significantly in the United States, it still remains a serious American health threat. When detected early, cervical cancer is generally curable. Early lesions are treated surgically, and locally advanced lesions are managed with concurrent cisplatin chemotherapy and pelvic radiation. Metastatic disease or recurrent lesions not amenable to radical local excision or regional radiation are treated with palliative chemotherapy. Current chemotherapeutic regimens are associated with significant side effects and only limited activity making the identification of active and tolerable novel targeted agents a high priority. Angiogenesis is central to cervical cancer development and progression. The dominant role of angiogenesis in cervical cancer seems to be directly related to HPV inhibition of p53 and stabilization of HIF-1 alpha, both of which increase VEGF. Bevacizumab binding and subsequent inactivation of VEGF seem to shrink cervical tumors and delay progression without appreciable toxicity, and are therefore being studied in a Gynecologic Oncology Group (GOG) phase III trial. Other intracellular tyrosine kinase inhibitors (TKIs) of angiogenesis such as pazopanib are also encouraging, especially in lieu of their oral administration. Further study of angiogenesis and its inhibition are ongoing.