Adjuvant chemotherapy after concurrent chemoradiation therapy for locally advanced cervical cancer.

Abstract

6031 Background: Standard treatment nowadays for locally advanced cervical cancer (LACC) is concurrent chemoradiation therapy (CCRT). However, due to distant metastasis, survival outcomes are still not optimistic. We tried to evaluate the clinical efficacy and safety of adjuvant chemotherapy for patients with LACC after treated with concurrent chemoradiation therapy (CCRT). Methods: Patients diagnosed between May, 2013 to May, 2018 with stage IIA-IIIB LACC were retrospectively analyzed. All the patients received platinum-based radical concurrent chemoradiotherapy and were divided into two groups: adjuvant chemotherapy after CCRT (CCRT+ACT group) and observation after CCRT (CCRT group). Overall survival (OS), progression free survival (PFS) and adverse effects were recorded and analyzed. Kaplan–Meier method and log-rank test were used to calculate and compare differences between survival outcomes. Toxicities were analyzed using chi-square test. Results: In total, 375 patients were included in this study, and 262 patients accepted ACT after CCRT while the remaining 113 patients chose to observe. With a median follow-up of 40 months (range 5-73 months), no significant differences were found in both overall survival (OS) and progression free survival (PFS) between two groups referring as 88.5% vs. 90.3% ( P= 0.904) and 83.2% vs. 87.6% ( P= 0.374). OS rates for patients in CCRT+ACT and CCRT groups at 1 year and 3 years were 97.3% vs. 94.7% ( P= 0.195) and 90.2% vs. 88.4% ( P= 0.694), respectively. Meanwhile, PFS rates at 1 year and 3 years were 92% vs. 94.7% ( P= 0.371) and 87.5% vs. 85.5% ( P= 0.761) for two arms separately. 3-4 grades acute adverse events happened more frequently in CCRT+ACT group than in CCRT group, with significant differences in neutropenia and anemia ( P <0.05). Conclusions: In this study, adjuvant chemotherapy after concomitant chemoradiotherapy did not show benefit of survival but do induce adverse effects. We do not suggest it unless further large scale randomized controlled trials are executed to verify it.

Efficacy and safety of nimotuzumab combined with chemoradiotherapy in the treatment of locally advanced cervical cancer

“…However, it has been reported that recurrence or metastasis occurs in 35-40% of LACC patients after chemoradiotherapy, with a 5-year OS of only 70% (5,16). The current study concluded that consolidation chemotherapy after CCRT not only improved PFS and OS in LACC patients (17) but also increased the incidence of grade 3 and 4 bone marrow suppression (P<0.05) (18). RTOG 0417 was a clinical trial of bevacizumab (an anti-angiogenic agent) combined with CCRT as the primary treatment for LACC patients.…”

Updates on systemic therapy for cervical cancer

“…Though not standard practice, adjuvant chemotherapy in cervical cancer has been examined in various settings, especially in advanced non-metastatic disease 18 23 24 25 26 . Earlier studies with mitomycin and 5-FU as adjuvant treatment did not prove to beneficial 23 , whereas studies with cisplatin plus gemcitabine were associated with increased toxicity, though beneficial 18 .…”

“…On a similar note, the ACTLACC trial 25 tested paclitaxel plus carboplatin as adjuvant therapy after CCRT but was closed prematurely as there was no significant improvement in response rate and survival 25 . A large RCT was recently presented at ASCO (Americian Society of Clinical Oncology) comparing CCRT followed by adjuvant chemotherapy versus CCRT alone for locally advanced (stage IIA-IIIB) cervical cancers 26 , reporting failure to achieve benefits for adjuvant chemotherapy with increasing toxicity 26 .…”