Pretesting cervical tumors could inform treatment

Doctors at Washington University School of Medicine in St. Louis have shown that 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 that radiation does the majority of the work with cervical cancer," said Schwarz, who treats patients at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. "But a randomized trial published in 1999 showed that 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 that every patient receives. Now, Schwarz and her colleagues have shown that 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.

The study appears online in the journal Gynecologic Oncology.

“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.”

A cervical tumor is a tumor, or abnormal growth, on the cervix and is a condition that primarily indicates cervical cancer. Cervical cancer is the second leading type of cancer in women, behind breast cancer. A cervical tumor results from abnormal cell growth and has been linked to the human papilloma virus, for which there is now a vaccine for certain strains. Cervical cancer can be detected with a laboratory test that examines cervical cells obtained through a gynecological procedure called a Pap test.

Like other types of cancer, cervical cancer is staged based on characteristics. Staging depends on the formation of a cervical tumor and whether or not the cervical tumor is confined to the cervix alone or has metastasized to other areas of the vagina or pelvis.