Neoadjuvant chemotherapy in locally advanced cervical cancer: real-world data from the Cancer Medicines Outcomes Programme (CMOP)

Abstract

To report the outcomes of neoadjuvant chemotherapy (NACT) in patients with locally advanced cervical cancer, we conducted a retrospective study of 126 patients. Methods: The electronic chemotherapy prescribing system was used to identify patients from the West of Scotland Cancer Network who received NACT over a 5 year period. Baseline characteristic and treatments details were collected. Association of treatment type and other variables with overall survival (OS) were analysed using Cox proportional hazards model. Results: The median follow up was 30 months. Median age was 44 years (interquartile range 34-54), 86% had squamous pathology and 93% had at least International Federation of Gynaecology & Obstetrics (FIGO) stage II disease at diagnosis. 27% had stage IV disease and 30% had para-aortic nodal involvement. NACT regimens consisted primarily of 3 weekly cisplatin/paclitaxel (63%) or carboplatin/paclitaxel (35%). 86% of patients subsequently received chemoradiotherapy (CCRT), 11% radical radiotherapy alone and the remaining patients progressed or defaulted. Three year OS was 61.8% (95% CI (Confidence Interval) 53.4-71.6). Survival was poorer in patients with neutrophil lymphocyte ratio (NLR) ≥5 (hazard ratio 2.8 (95% CI 1.32-5.90)) and in those not receiving CCRT (hazard ratio 2.23 (95% CI 1.01-4.91)). Conclusions: Three year OS was reasonable considering the advanced nature of the cohort and suggests that NACT is an option for women with bulky cervical cancer.