Chemotherapy for Cervical Cancer

Chemotherapy drugs are used to kill cancer cells. These drugs can be used to eliminate tumors and help with symptoms.

Chemotherapy is called adjuvant (additional) when it is given after surgery to prevent the cancer from coming back. Even if the surgery removes the original (primary) tumor, a small number of cancer cells might have escaped to other parts of the body. The chemotherapy is used to get rid of these cells.

Chemotherapy is called neoadjuvant when it is given before surgery to help shrink the tumor and make it more amenable to surgery.

Chemotherapy for cervical cancer is usually given intravenously (injected into a vein). The medicine travels through the bloodstream to all parts of the body. Chemotherapy can attack cancer cells that have already spread beyond the cervix to lymph nodes (small, bean-shaped collections of immune system cells that help fight infections) and other organs. These drugs kill cancer cells, but can also damage some normal cells. This damage to normal cells can cause side effects.

The National Comprehensive Cancer Network (NCCN) recommends using the following drugs as first-line chemotherapy for cervical cancer:

• Platinol^® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends upon the type of cancer you have, your size, and how well your kidneys work.
• Paraplatin ^® (carboplatin) - Carboplatin is a platinum chemotherapy drug that belongs to a group of drugs known as alkylating agents. It stops cancer cells from growing, which kills them. Carboplatin is given as an injection in the vein over 15 to 60 minutes. The dose depends upon your size, but may be lowered or not given if your blood counts are low. It can also be given as an infusion into a vein over 24 hours or directly into the peritoneal cavity in advanced ovarian cancer.
• Taxol^® or Onxol^® (paclitaxel) - Paclitaxel belongs to a group of chemotherapy drugs known as taxanes. It is also called a mitotic inhibitor because it affects cells during mitosis (cell division). It stops cells from dividing, which kills them. Paclitaxel is given by an injection into a vein, usually over a 3-hour period, every 3 weeks. Sometimes, smaller doses are given once a week over shorter periods. The dose depends on your weight, how well your liver works, the side effects you have, and how often the medicine is given.
• Hycamtin ^® (topotecan) - Topotecan hydrochloride belongs to the group of chemotherapy drugs known as topoisomerase inhibitors. Topotecan hydrochloride stops cancer cells from growing by preventing the development of elements necessary for cell division. Topotecan hydrochloride is given by a shot in the vein over 30 minutes for 3 to 5 days; this is usually repeated every 3 to 4 weeks. The dose and schedule depend on your weight, your blood counts, how well your kidneys are working, and the type of cancer being treated.
• Gemzar ^® (gemcitabine) - Gemcitabine belongs to a group of chemotherapy drugs known as antimetabolites. Gemcitabine prevents cells from making DNA and RNA, which stops cancer cells from growing; this kills the cancer cells. Gemcitabine is given as an injection in a vein over 30 minutes. It is usually given once a week for 3 weeks, followed by 1 week off. The dose depends on your size, your blood counts, and the cancer being treated.

Sometimes these drugs are used in combination. For example, cisplatin may be used with paclitaxel, topotecan, or gemcitabine, and carboplatin may be used in combination with paclitaxel.

NCCN recommends the following drugs as second-line chemotherapy for cervical cancer that has not responded to first-line chemotherapy:

• Taxotere ^® (docetaxel) - Docetaxel belongs to the group of chemotherapy drugs known as taxanes. It is also called a mitotic inhibitor because of its effect on the cell during mitosis (cell division). Docetaxel stops cancer cells from growing, which kills them. Docetaxel is given by a shot in a vein over 1 hour every 3 weeks, or in lower doses every week. The dose depends on your size, how well your liver is working, and how often the medicine is given.
• Ifex ^® (ifosfamide) - Ifosfamide belongs to a group of chemotherapy drugs known as alkylating agents. Ifosfamide stops cancer cells from growing and kills them. Ifosfamide is given as an injection in a vein over 1 to 24 hours for a few days. The dose depends on your size, how well your kidneys are working, your blood counts, and the type of cancer being treated.
• Navelbine ^® (vinorelbine) - Vinorelbine tartrate belongs to the group of chemotherapy drugs known as plant (vinca) alkaloids. Vinorelbine tartrate stops cells from dividing, which kills them. Vinorelbine tartrate is given by an injection in the vein over 5 to 10 minutes. The dose depends on your weight, how well your liver is working, your blood counts, and the type of cancer being treated.
• Camptosar ^® (irinotecan) - Irinotecan belongs to a group of chemotherapy drugs known as topoisomerase inhibitors. Irinotecan stops cancer cells from growing by preventing the development of elements necessary for cell division. Irinotecan is given by an injection in a vein over 90 minutes weekly for 3 weeks and then one off or once every 3 weeks. The dose depends on your size, your age, whether you have had radiation to your abdomen/pelvis, how well your liver is working, your blood counts, and whether you have had any side effects such as diarrhea.
• Ellence ^® , Farmorubicin ^® , or Pharmorubicin ^® (epirubicin) - Epirubicin hydrochloride belongs to the group of chemotherapy drugs known as anthracycline antibiotics. It stops cancer cells from growing, which kills them. Epirubicin hydrochloride is given as a shot in a vein over about 15 minutes. The dose and how often you get epirubicin hydrochloride depend upon your size, your blood counts, how well your liver is working, and the type of cancer being treated.
• Mutamycin^® (mitomycin) - Mitomycin belongs to a group of chemotherapy drugs known as antibiotics but it acts like an alkylating agent. It blocks the cell from making DNA, which results in cell death. Mitomycin is given by an injection in a vein over 20 minutes every 6 to 8 weeks. The dose and how often you get the medicine depend on your weight, your blood counts, how well your kidneys work, and the type of cancer you have.
• Adrucil ^® or Efudex ^® (5-fluorouracil or 5-FU) - 5-FU belongs to the group of chemotherapy drugs known as antimetabolites. 5-FU prevents cells from making DNA and RNA, which stops cells from growing. 5-FU is given as a shot in the vein over 5 to 10 minutes, over 20 to 60 minutes, or continuously over 22 to 24 hours for 1 to 4 days or longer. The treatment can be repeated weekly, every other week, or every 3 weeks. The dose depends on your size.

This content has been reviewed and approved by Myo Thant, MD.