Treatment of invasive cervical cancer is affected by the stage of the disease, which is based on clincal evaluation.

Chemotherapy: 

Single-agent chemotherpay can be divided into those who received plantinum-based therapy and those who received nonplatinum-based therapy. Cisplatin is regarded as the most active agent in carcinoma of the cervix. Platinum analogs such as Carboplatinhave been investigated in an effort to reduce toxicity.

Combination chemotherapy: 

Combination chemotherapy incldues drugs that have single agent-activity, nonoverlapping toxicity, and additive or synergistic activity with no incrase in toxicity in order to improve response rates and survival. For example, cisplatin has been combined with 5-fluoruracil, bleomycin, ifosfamide, gemcitabine, vinorelbine, paclitaxel, and topotecan in phase II-III trails. These trials showed advantage in response rates when compared with single-agent cisplatin.

Chemoradiotherapy 

Chemoradiotherapy is the treatment of choice for patients with stage IB2 disease (tumour >4cm), invasive carcinoma, confined to cervix). An RCT showed that adding weekly cisplatin to pelvic radiotheraphy before hysterectomy reduced the risk of recurrence of disease and death compared with radiotheraphy and hysterectomy alone.

Three RCTs have shown that improvements in progression free survival and overall survival are greater for chemoradiotheraphy than for radiation alone in patients with locally advanced stage IIB-IVa disease. Platinuum based chemoradiotheraphy is now the standard of care for these patients.

Patients with early stage disease have a high risk of recurrence postoperatively if they have one of the following risk factors: postive nodes, parametrial invasion, or positive surgical margins. Such patients should receive adjuvant cisplatin based chemoradiotheraphy after hysterectomy, as shown by an RCT.

There is a lot of conflicting published work regarding the treatment of builky stage Ib-IIa cervical cancer. While some centers are performing primary surgery as for Ib1 disease followed by tailored postoperative radiation with or without chemotheraphy, the others are in favor of primary chemo-radiation therapy. Neoadjuvant chemotheraphy followed by radical surery has emerged as a possible alternative which may imporve a surfival in patients with stage Ib2 disease.

Concomitant chemoradiation is becoming a new standard in treatment of advanced disease, because it has been clearly shown to improve disease-free, progression-free and overall survival.

The management of recurrent cervix carcinoma has not improved significantly with modern chemotherapy due to several factors. First, carcinoma of the cervix has limited sensitivity to cytotoxic agents, especially when it recurs in the irradiated pelvis. Second, the median response duration is usually 3-70 months. Third, there is a difficulty in showing a meaninful incrase in survival of the patient population as a whole. Fourth, there is refractoriness among patients who have failed any prior chemotherapy.

EGFR Inhibitors:

Activation of EGFR triggers a cascade of events leading to cell reproduction. 

Tarceva (N-(3-ethynylphenyl)-6,7-bis(2-methoxyethoxy)-4-quinazo-linamine): has been shown to be useful for treatment of tumors caused by HPV. (see US Patent NO: 6,900,221). 

Radiotheraphy: 

Patients with early stage disease have an intermediate risk of recurrence postoperatively if they have two of the following factors: large tumour size, deep stromal invasion, or involvement of the lymphovascular space. An RCT evaluating 277 women with stage IB disease versus “no further treatment” and at least two risk factors showed that adjuvant radiotheraphy decreased the rate of recurrence and imporved disease free survival.

–Radical hysterectomy:

Radical hysterectomy is the treatment of choice for young healthy patients because it preserves ovarian function. It is thought to be equally effective for patients with early stage disease.

Most often, stage Ib1 cervical cancer is treated by radical hysterectomy with pelvic lymphadenectaomy. Laparoscopically assisted radical vaginal hysterectomy has shown similar efficacy and recurrence rates.

Natural Medicines

Artemisinin: US Patent Publication No. US2007/0142459 discloses methods of treating proliferative cervical disorders by administering a therapeutically effective amount of artemisinin-related compounds. In some embodimetnes, artemisinin or an artemisinin derivative, combined with other anti-viral or anti-cancer therapies such as radiation theraphy are used. Other agents known for their use in the inhibition of cervical cancer include interleukin-2,5′-fluorouracil, nedaplatin, methotrexate, vinblastine, doxorubicin, carboplatin, paclitaxel (Taxol), cisplatin, 13-cis re-moic acid, pyrazoloacridine, and vinorelbine.

Artemisinin (Oinghasosu) is a naturally occuring substance, obtainec by purificatoin from sweet wormwood, Artemisia annua. Artemisinin and its analogs are sesquiterpene lactones with a peroxide bridge. The very low toxicity of these compoudns to humans is a majro benefit.

Formulations of the artemisinin-related compounds suitable for oral administration may be in the form of capsules, pills, pwoders, etc. The topical formulations may include one or more of the wide variety of agents known to be effective as skin or stratum corneum penetration enhancers. Examples include 2-pymolidone, N-methyl-2-pyrrolidone, dimethylacetamide, dimethylformamide, propylene glycol, methyl or isopropyl alcholo, dimethyl sulfoxide and azone.

N,N-dimethylglycine: US Patent Publication Number 2006/0183801A1(Assignee, FoodScience, Corporation, Essix Junction, VT) discloses a method of treating, inhibiting the metasis of, or preventing cervical cancer by administering to a patient an effective amount of N,N-dimethylglicine or a pharmaceutically acceptable salt thereof.