Abstract
Simple SummaryVulvar cancer is a difficult clinical condition to treat. Although it is not one of the most frequently diagnosed cancers, its incidence is not negligible. Treatment depends on the extent of the disease and is currently based on surgery, radiotherapy and chemotherapy. The combination of these possible treatments, in the context of multidisciplinary discussions, is crucial. In this paper we present a review of the data available in the literature on the role of chemotherapy in the treatment of vulvar cancer, with a look at future perspectives. The actual role of chemotherapy in vulvar cancer is undeniably a niche topic. The low incidence of the disease limits the feasibility of randomized trials. Decision making is thus oriented by clinical and pathological features, whose relevance is generally weighted against evidence from observational studies and clinical practice. The therapeutic management of vulvar cancer is increasingly codified and refined at an individual patient level. It is of note that the attitude towards evidence sharing and discussion within a multidisciplinary frame is progressively consolidating. Viable options included in the therapeutic armamentarium available for vulvar cancer patients are frequently an adaption from standards used for cervical or anal carcinoma. Chemotherapy is more frequently combined with radiotherapy as neo-/adjuvant or definitive treatment. Drugs commonly used are platinum derivative, 5-fluorouracil and mitomicin C, mostly in combination with radiotherapy for radiosensitization. Exclusive chemotherapy in the neo-/adjuvant setting comprises platinum-derivative, combined with bleomicin and methotrexate, 5-fluorouracil, ifosfamide or taxanes. In advanced disease, current regimens include cisplatin-based chemoradiation, with or without 5-fluorouracil, or doublets with platinum in combination with a taxane. Our work is also enriched by a concise excursus on the biologic pathways underlying vulvar cancer. Introductory hints are also provided on targeted agents, a rapidly evolving research field.
Highlights
The incidence rate of vulvar cancers is set at about two to three newly diagnosed cases out of 100,000 women per year
The use of 5-fluorouracil and cisplatin combined with radiotherapy in 12 locally advanced vulvar cancer patients resulted in a 67% clinical complete response rate [19]
Pathological complete response was exclusively reported in one patient, while carcinoma in situ was described in two patients [56]
Summary
The incidence rate of vulvar cancers is set at about two to three newly diagnosed cases out of 100,000 women per year. Radical surgery in early stages, adjuvant radiotherapy in the case of node involvement or positive resection margins and chemoradiation for more advanced stages represent some of the basic tenets of current treatment orientations [8]. In locally advanced vulvar cancer, upfront surgery lacks appropriate indication In these patients, the combination of chemoradiation may be the preferred choice. The main focus is set on palliative care and quality of life To this purpose, chemoradiation or systemic chemotherapy or, more recently, their combination with immunotherapy or biologic agents, represent valuable options [9]. In the with metastatic setting, the the case of nodal involvement and/or positive resection margins no chance for remain focus is set on palliative care and quality of life.radiotherapy To this purpose, chemoradiation or excision, postoperative adjuvant inguinal and pelvic are appropriate. In more detail, according to the results of adjusted Cox proportional regression models including data from 1797 patients, the outcome analysis translated into a 38% risk reduction in patients treated with adjuvant chemotherapy (p < 0.001) [17]
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