Pretesting Cervical Tumors Predicts Response To Treatment
ST. LOUIS, Mo. – Doctors at Washington University School of Medicine in St. Louis have shown testing cervical tumors before treatment for vulnerability to chemotherapy predicts whether patients will do well or poorly with standard treatment. The study supports the future possibility of personalized medicine for cervical cancer, a tumor normally addressed with a one-size-fits-all approach. “Even though this is a small study, its strength is that it links a lab test of the tumor’s chemotherapy response to survival outcomes for the patients,” said Julie K. Schwarz, MD, PhD, assistant professor of radiation oncology. “Very few cancers have been studied this way, and this is the first such report for cervical cancer.” Since 1999, nearly all cervical cancer cases have been treated the same way: daily radiation therapy targeted to the tumor plus a weekly intravenous infusion of the chemotherapy drug cisplatin. “We believe radiation does the majority of the work with cervical cancer,” said Schwarz. “But a randomized trial published in 1999 showed combining it with cisplatin chemotherapy improved survival outcomes.” Even today, according to Schwarz, doctors have no way of knowing who will do well or poorly with the combined radiation and chemotherapy every patient receives. Now, Schwarz and her colleagues have shown the tumor’s response to chemotherapy, independent of radiation, may be a major deciding factor in whether a patient will do well with the standard treatment. “This is evidence that cisplatin is not just helping the radiation work better,” Schwarz said. “It is having some direct toxic effect on cancer cells that may be hiding elsewhere in the body, some place where the radiation is not hitting it, since we target the radiation so precisely to the main tumor. We think it would be beneficial for that drug to be selected appropriately for the patient’s individual tumor.” Cervical cancers can be divided into two main types based on how they look under a microscope – squamous cell carcinoma and adenocarcinoma. The nonresponsive number was even worse for patients diagnosed with the more common squamous cell carcinoma, with 46 percent disease-free survival at two years.