What is the treatment for recurrent cervical cancer with omental (omentum) metastases?

Treatment for Recurrent Cervical Cancer with Omental Metastases

For recurrent cervical cancer with omental metastases, the preferred first-line treatment is systemic therapy with paclitaxel-cisplatin-bevacizumab. 1

First-Line Systemic Therapy Options

Preferred Regimens:

• Paclitaxel-cisplatin-bevacizumab (Category I, A evidence) 1

  • Cisplatin 50 mg/m² on day 2
  • Paclitaxel 135 mg/m² over 24 hours on day 1
  • Bevacizumab 15 mg/kg every 3 weeks
  • This regimen demonstrated significant improvement in overall survival (16.8 vs 13.3 months) compared to chemotherapy alone 1

• Carboplatin-paclitaxel-bevacizumab (Category 2B) 1

  • Alternative for patients who cannot tolerate cisplatin
  • Carboplatin AUC 5 on day 1
  • Paclitaxel 175 mg/m² over 3 hours on day 1
  • Bevacizumab 15 mg/kg every 3 weeks

Other Recommended Regimens:

• Cisplatin-paclitaxel (without bevacizumab) 1
• Carboplatin-paclitaxel (without bevacizumab) 1, 2
• Single-agent cisplatin or carboplatin 1

Treatment Selection Considerations

1. Prior platinum exposure:

   • For patients without prior cisplatin exposure, cisplatin-based regimens are superior (median OS 23.2 vs 13.0 months) 2
   • For patients previously treated with platinum, carboplatin-based regimens show non-inferiority to cisplatin (HR 0.994) 2

2. Performance status:

   • For patients with good performance status (ECOG 0-1), combination therapy with bevacizumab is preferred 1
   • For patients with poor performance status, consider single-agent therapy or dose modifications

3. Toxicity management:

   • Monitor for bevacizumab-specific adverse events:
     • Hypertension (25% vs 1.8% for grade 2)
     • Venous thromboembolic events (8.2% vs 1.8% for grade 3)
     • Fistula formation (8.6% vs 1% for grade 2) 1
   • Withhold bevacizumab for at least 28 days prior to elective surgery and 28 days following major surgery 3

Surgical Considerations

For isolated omental metastasis, surgical resection may be considered in highly selected cases:

• Surgical resection followed by systemic therapy can be considered for select cases of isolated recurrence 1
• Case reports suggest potential long-term complete remission in patients with isolated omental recurrence treated with surgical resection followed by adjuvant chemotherapy 4
• Factors favoring surgical approach:
  • Single site of metastasis
  • Good performance status
  • Long disease-free interval
  • Technically resectable disease

Second-Line Therapy Options

If disease progresses after first-line therapy, second-line options include:

• Paclitaxel (single agent) 1
• Topotecan 1
• Gemcitabine 1
• Cisplatin-gemcitabine (Category 2B) 1
• Cemiplimab (for patients who have progressed on prior therapy) 1
• Pembrolizumab (for recurrent or metastatic disease with progression) 1

Monitoring and Follow-up

• Clinical examination every 3 months for the first 2 years
• Imaging studies (CT chest/abdomen/pelvis) every 2-3 months to assess disease response
• Monitor for treatment-related toxicities at each visit

Prognosis

The prognosis for recurrent cervical cancer with distant metastases is generally poor:

• Median overall survival with platinum-based combination therapy: 12-17 months 1, 2
• Median progression-free survival: 5-6 months 1, 5
• Response rates: 36-58% depending on regimen and line of therapy 5

For patients with isolated omental metastasis who undergo complete surgical resection followed by systemic therapy, longer disease-free intervals may be possible in carefully selected cases 4.