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Induction chemotherapy shows significant improvements for survival in patients with locally advanced cervical cancer.
Short-course induction chemotherapy followed by chemoradiotherapy significantly improved survival in patients with locally advanced cervical cancer compared to chemoradiotherapy alone.
Among patients with locally advanced cervical cancer, short-course induction chemotherapy followed by chemoradiotherapy significantly was shown to improve survival compared with chemoradiotherapy alone, according to study findings published in The Lancet.
“This short-course induction chemotherapy regimen followed within seven days by chemoradiotherapy improves survival of patients with locally advanced cervical cancer,” study authors wrote. “It should now be considered a standard of care and be included in the design of future trials that explore the incorporation of new agents for the treatment of locally advanced cervical cancer.”
After a median follow-up of 67 months, the five-year progression-free survival rates were 72% and 64% in the induction chemotherapy with chemoradiotherapy group and chemoradiotherapy alone group, respectively. Regarding overall survival, five-year rates were 80% in the induction chemotherapy with chemoradiotherapy group and 72% in the chemoradiotherapy alone group.
Additionally, pelvic lymph nodes were positive in 215 patients, and 230 patients who received induction chemotherapy had at least five cycles. The median interval between induction chemotherapy and chemoradiotherapy was seven days.
Chemoradiotherapy: combines chemotherapy and radiotherapy to destroy cancer cells.
Progression-free survival: time from randomization to date of progression or death.
Overall survival: the time from randomization to date of death from any cause.
Neutropenia: lack of white blood cells.
Dyspnea: shortness of breath.
Demonstrated side effects were severe grade or worse among 147 out of 250 patients experiencing side effects in the induction chemotherapy group versus 120 out of 250 patients in the chemoradiotherapy alone group. More patients in the induction chemotherapy group had hematological side effects of severe grade or worse (74 versus 32 patients; largely neutropenia).
“As expected, hematological toxicity (mainly neutropenia) was more common with induction chemotherapy with chemoradiotherapy, particularly during chemoradiotherapy,” study authors wrote.
Specifically, among patients in the induction chemotherapy group, 54 had severe grade or worse side effects during the induction phase. Neutropenia occurred in 18 patients, and all other side effects had a frequency of less than 3%, including anemia (four patients). In addition, infection was reported in six patients, mild hair loss in 39 and moderate hair loss in 106. Mild to moderate grade peripheral neuropathy, fatigue, constipation and dyspnea were more common in the induction chemotherapy group, but they were all transient.
Three deaths occurred within 30 days of completing treatment. One resulted from respiratory failure in the induction chemotherapy group, and two from sepsis and pulmonary embolism in the chemoradiotherapy alone group. All deaths were considered not treatment related.
A total of 500 patients (median age of 46 years) were enrolled with 250 assigned to the chemoradiotherapy alone group and 250 patients assigned to the induction chemotherapy with chemoradiotherapy group. Out of the 500 patients, 354 had stage 2B disease and 56 had stage 3B disease.
A total of 212 participants in the induction chemotherapy with chemoradiotherapy group received four or more cycles of cisplatin. In comparison, 224 participants in the chemoradiotherapy alone group also received the same treatment. Additionally, 462 participants underwent external beam radiotherapy and brachytherapy, with a median overall treatment duration of 45 days.
The induction chemotherapy regimen consisted of carboplatin and paclitaxel at a dose of 80 milligrams per square meter (mg/m²), administered once a week for six weeks. This was followed by chemoradiotherapy, which began in week seven. In both groups, the chemoradiotherapy included external beam radiation therapy combined with cisplatin at a dose of 40 mg/m², given once a week for five weeks, along with brachytherapy.
“This represents the first published substantial overall survival improvement among patients with locally advanced cervical cancer since concomitant cisplatin over two decades ago,” study authors mentioned.
Reference:
“Induction chemotherapy followed by standard chemoradiotherapy versus standard chemoradiotherapy alone in patients with locally advanced cervical cancer (GCIG INTERLACE): an international, multicentre, randomised phase 3 trial” by Dr. Mary McCormack, et al., Lancet.
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