Cervical Cancer

Cervical cancer is the most common cause of death from cancer in women worldwide. Although prevention strategies are effective and have decreased the incidence of cervical cancer in this country, more needs to be done. Utilization of new HPV DNA strategies may help identify a group of women who are at high risk for preinvasive and invasive cervical lesions. The multidisciplinary cervical cancer program at Montefiore Medical Center and the Albert Einstein College of Medicine focuses on the development of innovative approaches for the early detection of cervical lesions as well as new strategies for prevention of HPV. New adjuvant therapies in combination with radiation therapy have been integrated into the treatment of patients with primary or recurrent cervical cancer.

A number of patients with cervical cancer have been referred to Albert Einstein College of Medicine from other centers for a second opinion. All of the patients' pathology and previous therapies are reviewed at a weekly multidisciplinary conference at the Weiler campus. The team consists of Gynecologic Oncologists, Radiation Oncologists, Medical Oncologists and Pathologists who discuss the findings and recommend a treatment plan. Patient-specific treatment planning consists of either a surgical option with or without combination-modality chemoradiotherapy. Innovative research protocols that utilize novel and the most promising agents are offered to patients with cervical disease. Gary L. Goldberg, MD, Director, Division of Gynecologic Oncology, coordinates the conference.

Researchers at the Albert Einstein College of Medicine are studying the immune pathways involved in the progression of a preinvasive lesion to cervical cancer. Under the direction of Dr. Anna Kadish, the cell-mediated immune responses of patients with preinvasive and invasive lesions are being studied. Recently, antibodies to conformational epitopes on the HPV virion or synthetically produced virus-like particles (VLPs) have been shown to develop in response to type specific infection. Available data indicates that cervical cancer develops through progressive stages from a preinvasive to invasive cancer. It appears that chronic infection with HPV increases the susceptibility of cells to malignant changes. However, while HPV is necessary to induce preinvasive and/or invasive cervical cancer; other cofactors are required. Using a novel, highly sensitive ELISA assay incorporating VLP reagents from oncogenic HPVs in our population, Dr. Robert Burk and colleagues are trying to determine the presence and titer of HPV-VLP antibodies (IgG and IgA) and their association with severity of disease.

Recently, VLPs have been combined with a heat shock protein in a vaccine. Phase 1 studies have revealed that this type of vaccination is safe with minimal toxicity. Under the direction of Drs. Anna Kadish and Gary L. Goldberg, this vaccine will be used for treatment in patients with preinvasive high-grade intraepithelial neoplasia. Intermediate clinical biomarkers will be obtained to identify if a host immune response is mounted.

Multiple therapeutic trials are being tested for the treatment of patients with recurrent cervical cancers. To find out more about ongoing cervical cancer studies or to refer patients for clinical investigation, please contact (718) 405-8082. Patients are referred back to their referring physicians' offices after completing the program.