A prospective study on neoadjuvant chemoradiotherapy plus anti-EGFR monoclonal antibody followed by surgery for locally advanced cervical cancer

Abstract

BackgroundTo investigate the efficacy and safety of neoadjuvant chemoradiotherapy plus anti-epidermal growth factor receptor monoclonal antibody followed by surgery for locally advanced cervical cancer (LACC).Patients and methodsPatients with histologically proven LACC were enrolled into this prospective study. All patients received intensity-modulated radiation therapy with conventional fractionation. Weekly cisplatin or nedaplatin was administered concurrently with intensity-modulated radiation therapy. Nimotuzumab, a humanized anti-epidermal growth factor receptor monoclonal antibody, was given at a dose of 200 mg per week for 6 cycles. Approximately 1 month after the completion of neoadjuvant treatment, the patients were assessed for clinical tumor response and operability based on MRI and gynecological examination. For those who were considered to be candidates for surgery, radical hysterectomy, and pelvic lymph node dissection were performed 5–6 weeks after the completion of neoadjuvant therapy.ResultsTwenty-eight patients were enrolled. Clinical complete response and partial response were found in 8 (28.5%) and 20 (71.5%) patients, respectively. Four patients were not eligible for surgery and 2 patients refused surgery although they were assessed as surgical candidates. They were not included in this analysis. Radical hysterectomy and pelvic lymph node dissection were performed for the remaining 22 patients. Among them, 8 (36.4%) had complete pathology response, 9 (40.9%) presented with persistent atypical cells or cervical intraepithelial neoplasia, and 5 (22.7%) presented with macroscopic and/or microscopic residual disease, according to the pathological evaluation. Median follow-up time was 22 months (range, 5–39 months). The 2-year locoregional control rate, progression-free survival rate, distant metastasis-free survival rate, and overall survival rate were 95.0%, 85.2%, 84.0%, and 90.0%, respectively. Acute toxicities were mild in general and easily manageable. Chronic toxicities were mainly limited to grade 1. No severe late toxicities were observed.ConclusionConcurrent chemoradiotherapy plus nimotuzumab followed by surgery is highly effective and safe in LACC. Further studies are warranted to confirm the findings.

Surgery of primary sites for stage IVB cervical cancer patients receiving chemoradiotherapy: a population-based study

“…Despite the use of surgery being contraindicated in metastatic cervical cancer, it may be used highly personalized either for in case of particularly favorable clinical outcome or palliative intent. Promising data from studies disclose new perspectives of surgery in locally advanced cervical cancer (LACC) patients [151718192021]. In our study, compared with CRT group, addition of surgery was inclined to prolong OS in multivariate analysis, which extended from 19 to 32 months, which offers more possibility for the treatment of stage IVB cervical cancer.…”

<p>Clinical study of nimotuzumab combined with concurrent radiochemotherapy for treatment of locally advanced cervical cancer</p>

“…A total of 28 patients were enrolled, 28.5% of which achieved complete remission and 71.5% who achieved partial remission, after completion of neoadjuvant therapy. A total of 24 patients received surgery after neoadjuvant therapy 27. However, to date, there has been no published research on nimotuzumab combined with CCRT as a first-line treatment for LACC.…”

Nimotuzumab Combined With Irradiation Enhances the Inhibition to the HPV16 E6-Promoted Growth of Cervical Squamous Cell Carcinoma

“…After 1 month of neoadjuvant treatment, magnetic resonance imaging (MRI) and gynecological evaluations showed a complete clinical response rate of 28.5% and partial response rate of 71.5%. The median survival of the 24 patients who had undergone surgery was 22 months ( 34 ). Additional studies have investigated the mechanisms underlying the ability of nimotuzumab to sensitize cancer cells to radiotherapy.…”