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In Reply:

Indiana University School of Medicine, Indianapolis, IN

The authors appreciate the attention given by Drs Mano and Kerr to these two Gynecologic Oncology Group (GOG) trials, GOG 169 and GOG 110. In GOG 110, the cisplatin plus ifosfamide regimen seemed to yield similar results in terms of improved response rate and progression-free survival but without improvement of overall survival. Furthermore, it was difficult to determine the best regimen in that study, when therapy was not curative, higher response rates were associated with increased toxicity, and quality of life was not assessed. In addition, chemoradiotherapy was not standard therapy at that time, and some caution should be used when comparing clinical trials during an era when first-line treatment was undergoing a revolution.

The authors of GOG 169 concur that the trial was not powered for a subset analysis of chemoradiotherapy versus nonchemoradiation. However, there was no reason to believe that cisplatin alone was superior to the combination regimen in chemoradiotherapy-naive patients, and the response rates suggested inferiority even in this population.

We draw attention to results of GOG 179 (Long et al; manuscript under review), which are germane to this dialogue. In that study, the combination of cisplatin plus topotecan was found to be superior to cisplatin alone in terms of response rate, progression-free survival, and overall survival, with no appreciable difference in quality of life, in a population in which 60% of patients had received chemoradiotherapy (compared with 29% in GOG 169). The combination regimens from these two studies now comprise two of the four arms being compared in the current randomized phase III trial known as GOG 204, and plans for a multivariate analysis to address predictors of poor response to cisplatin-based chemotherapy are underway (with possible separation of these patients into noncisplatin-containing investigations).

Author's Disclosures of Potential Conflicts of Interest

The author indicated no potential conflicts of interest.

REFERENCES

1. Moore DH, Blessing JA, McQuellon RP, et al: Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: A Gynecologic Oncology Group Study. J Clin Oncol 22:3113-3119, 2004[Abstract/Free Full Text]

2. Omura GA, Blessing JA, Vaccarello L, et al: Randomized trial of cisplatin versus cisplatin plus mitolactol versus cisplatin plus ifosfamide in advanced squamous carcinoma of the cervix: A Gynecologic Oncology Group study. J Clin Oncol 15:165-171, 1997[Abstract/Free Full Text]

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