Sustained Complete Response after Maintenance Therapy with Topotecan and Erlotinib for Recurrent Cervical Cancer with Distant Metastases
A 53-year-old woman was diagnosed with stage IB2 poorly differentiated squamous cell carcinoma of the cervix with lymphovascular invasion. She received definitive pelvic radiation therapy with concurrent cisplatin chemotherapy followed by brachytherapy. Six months after completion of treatment, positron emission tomography-computed tomography (PET-CT) showed recurrent disease to the common iliac and para-aortic lymph nodes above the previous radiation field. The patient was treated with additional radiation therapy to the common iliac and para-aortic lymph nodes. Two years later, PET-CT showed a hypermetabolic left supraclavicular lymph node, and fine-needle aspiration showed poorly differentiated carcinoma consistent with cervical cancer recurrence. The patient received additional chemoradiation with cisplatin encompassing the left supraclavicular area, cervical regions, and upper mediastinum. She subsequently received 3 cycles of adjuvant cisplatin and topotecan. PET-CT showed a complete response. Given the patient's high likelihood of recurrence, she was offered maintenance therapy with erlotinib based on previous study findings in NSCLC. She received therapy with low-dose topotecan (2 mg/m2 intravenous every 14 days) combined with erlotinib (100 mg orally daily). PET-CT scans were performed every 3–4 months during maintenance therapy and were negative for disease. Maintenance therapy was well tolerated and produced minimal side effects including mild fatigue and nausea. After 20 months of maintenance therapy, the treatment was discontinued given the long interval without any evidence of disease. Since then, the patient has undergone PET-CT yearly. The patient is currently without evidence of disease 5 years after completing the topotecan-erlotinib maintenance therapy. Of note, EGFR mutational testing was not performed in this case.\nA copy of the written consent form is available for review by the Editor-in-Chief of this journal on request.