Patient case: 26-year-old female with Cervical cancer. Genetic variant: STK11. Other conditions: None.

Clinical trial: Radiation Therapy, Paclitaxel, and Cisplatin in Treating Patients With Cancer of the Cervix

Summary: RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells. Paclitaxel and cisplatin may increase the effectiveness of radiation therapy by making the tumor cells more sensitive to the radiation. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining radiation therapy with chemotherapy may kill more tumor cells.
  PURPOSE: This phase I/II trial is studying the side effects and best dose of paclitaxel when given with radiation therapy and cisplatin and to see how well they work in treating patients with cancer of the cervix that has spread to the lymph nodes in the pelvis and abdomen.

Detailed description: OBJECTIVES:
  -  Determine the toxicity of extended field radiotherapy with concurrent paclitaxel and cisplatin chemotherapy (as radiation sensitization) in patients with previously untreated carcinoma of the cervix metastatic to the para-aortic lymph nodes.
  -  Determine the maximum tolerated dose of paclitaxel when combined with cisplatin plus extended field radiotherapy in this patient population.
  -  Determine the effect of this treatment regimen on progression-free survival, overall survival, and site of recurrence (local vs distant) in these patients.
  OUTLINE: This is a multicenter, dose-escalation study of paclitaxel.
  Patients receive external beam radiotherapy (RT) to the para-aortic nodes and the pelvis daily for 5 weeks; RT must be completed within 8 weeks of its initiation. During or after external beam RT, intracavitary radiation is administered 1-5 times. Concurrently with external beam RT, patients receive paclitaxel IV over 1 hour followed immediately by cisplatin IV on days 1, 8, 15, 22, 29, and 36.
  Cohorts of 3-6 patients receive escalating doses of paclitaxel until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which at least 2 of 6 patients experience dose-limiting toxicity.
  Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter or until the time of recurrence or death.
  PROJECTED ACCRUAL: A total of 20-40 patients will be accrued for this study within 4 years.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically proven previously untreated invasive carcinoma of the uterine cervix
  -  Squamous cell carcinoma
  -  Adenosquamous carcinoma
  -  Adenocarcinoma
  -  TNM classification stage IIIB or IVA (FIGO classification stage IB, IIA, IIB, IIIA, IIIB, or IVA)
  -  Cytologically or histologically proven metastases to the para-aortic lymph nodes
  -  No more than 8 weeks since diagnosis
  -  No metastases to scalene nodes, intraperitoneal metastases, or metastases to other organs outside the radiation field at the time of original clinical and surgical staging
  -  Negative CT scan of the chest
  -  Patients with ureteral obstruction must be treated with stent or nephrostomy tube
  PATIENT CHARACTERISTICS:
  Age:
  -  18 and over
  Performance status:
  -  GOG 0-2
  Life expectancy:
  -  At least 6 months
  Hematopoietic:
  -  Absolute neutrophil count at least 1,500/mm^3
  -  Platelet count at least 100,000/mm^3
  Hepatic:
  -  Bilirubin no greater than 1.5 times normal
  -  SGOT no greater than 3 times normal
  Renal:
  -  Creatinine less than 2.0 mg/dL
  -  No renal abnormalities (e.g., pelvic kidney, horseshoe kidney, or renal transplantation) requiring modification of radiation fields
  Other:
  -  Not pregnant
  -  No septicemia or severe infection
  -  No other invasive malignancy within the past 3 years except nonmelanoma skin cancer
  PRIOR CONCURRENT THERAPY:
  Biologic therapy:
  -  Not specified
  Chemotherapy:
  -  No prior cytotoxic chemotherapy for this or other malignancy
  Endocrine therapy:
  -  Not specified
  Radiotherapy:
  -  No prior radiotherapy for this or other malignancy
  -  No prior radiotherapy to pelvis or abdomen
  Surgery:
  -  Not specified
  Other:
  -  No other prior therapy for this malignancy

Relevance to patient case: not relevant