Treatment with existing drugs prior to standard treatment for cervical cancer can reduce recurrence and improve survival rates, a study has suggested.
The international research, funded by University College London (UCL) Cancer Trials Centre and Cancer Research UK (CRUK), assessed the effectiveness of a short course of induction chemotherapy (IC) prior to chemoradiation (CRT).
Preliminary results from the investigation were presented as an abstract at the European Society for Medical Oncology (ESMO) congress, Madrid, 20-24 October, 2023.
Every year there are around 3200 new cervical cancer cases, and around 850 cervical cancer deaths in the UK, according to CRUK figures.
CRT has been the standard treatment for locally advanced cervical cancer since 1999 but despite improvements in radiation therapy techniques, cancer returns in up to 30% of cases, and many patients die from metastatic disease, the study authors noted. "Those with locally advanced disease have a relatively high chance of relapse and the disease can take a huge toll on patients and their families," said senior author Professor Jonathan Ledermann from UCL Cancer Institute.
Eluned Hughes, head of information and engagement at Jo's Cervical Cancer Trust, said that in recent decades there had been "little improvement" in the survival rates of cervical cancer, and that the charity often heard from women who felt that they faced "limited treatment options."
Short Course of Induction Chemotherapy Prior To Chemoradiation
Building on a feasibility study that demonstrated a good response rate to short course weekly IC delivered before standard CRT, the researchers set out to assess whether this treatment regimen could reduce the rate of relapse and death among patients with locally advanced cervical cancer.
Over the course of 10 years (November 2012 to November 2022), 500 patients, with a median age of 46 years, were recruited from 32 centres in five countries – the UK, Mexico, India, Italy, and Brazil. Women with squamous, adeno, or adenosquamous carcinoma stage IB1 node positive, IB2, II, IIIB, IVA were eligible for the trial.
Patients were randomly allocated to receive either standard CRT—external radiation with weekly cisplatin and brachytherapy—or an initial 6-week course of IC—carboplatin and paclitaxel chemotherapy—followed by the same standard CRT. Median follow up time was 64 months.
Important Advance in Treatment
After 5 years, 80% of those who received IC plus CRT were alive, compared with 72% who had received standard treatment. Five-year progression free survival was 73% among patients who received IC plus CRT compared with 64% in those who received CRT alone.
Dr Mary McCormack from UCL Cancer Institute and UCL Hospital, who led the investigation, said, "Our trial shows that this short course of additional chemotherapy delivered immediately before the standard CRT can reduce the risk of the cancer returning or death by 35%." She described it as "the biggest improvement in outcome in this disease in over 20 years."
A New Standard of Care
Dr Iain Foulkes, executive director of research and innovation at CRUK, commented, "Timing is everything when you're treating cancer. The simple act of adding induction chemotherapy to the start of chemoradiation treatment for cervical cancer has delivered remarkable results in this trial."
The authors suggested that IC followed by CRT should be considered a new standard of care. They pointed out that since patients had been recruited from diverse health care settings, the treatment regimen was feasible in all countries.
Moreover, because the drugs required for IC, carboplatin and paclitaxel, were cheap, accessible, and already approved for use in patients, the authors hoped they could be incorporated into standard of care treatment relatively quickly.
"We're excited for the improvements this trial could bring to cervical cancer treatment and hope short courses of induction chemotherapy will be rapidly adopted in the clinic," expressed Dr Foulkes.
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