Neoadjuvant cisplatin plus ifosfamide in patients with stage IIB cervical cancer: a single center phase II study

Abstract

The objective of this study was to evaluate cisplatin plus ifosfamide as neoadjuvant chemotherapy with regard to toxicity and clinical response in patients with stage IIB cervical cancer. Sixty‐eight patients with previously untreated stage IIB cervical cancer were given two cycles of chemotherapy: cisplatin 20 mg m−2 on Days 1–5, infused over 1 h; ifosfamide 1.2 g m−2 on Days 1–5 infused over 30 min. Mesna 120 mg m−2 was administered as a bolus 15 min before ifosfamide, and a continuous infusion, delivering Mesna 1.2 g m−2, was given subsequently over the next 16 hours. The treatment cycle was repeated on day 21. Responders were then randomized to surgery or radiation therapy. All 68 patients were evaluable for toxicity. Toxicity was found to be acceptable. One patient died at home one month after completion of the second treatment cycle. There was one grade 4 thrombocytopenia. Grade 3 toxicities included anemia in four patients, leucopenia and nausea and vomiting in one patient each. Sixty‐two patients were evaluable for response. A clinical response was documented in 44 of the 55 evaluable patients (80%), with 17 complete responses (31%) and 27 partial responses (49%) (95% confidence limits 69%–91%, 19%–43%, and 36%–62% respectively). The intent‐to‐treat response rate was 64.7%. Twenty‐one patients were randomized to surgery and 23 patients to radiation therapy. Amongst the eight patients with a complete clinical response, one patient had a complete pathological response and one patient had residual intra‐epithelial neoplasia. The drug combination of cisplatin plus ifosfamide had acceptable toxicity and gave a clinical response rate of 80% in previously untreated patients with stage IIB cervical cancer.

Cisplatin Binding Sites on Human Albumin

“…It is likely that cross-peak c is paired with both peaks d and e/f, representing two cisplatin-albumin adducts (c-d and c-e/f) with similar sulfur donors and different types/environments of nitrogen/chloride donors. These adducts have different rates of formation and subsequent loss of NH 3 , which results in variations in their peak intensities at different times of reaction (Figs. 2 and 3).…”

“…Cisplatin, cis-[PtCl 2 (NH 3 ) 2 ], is extensively used for the treatment of testicular and ovarian cancers and increasingly against other types of solid tumors (head/neck, lung, cervical, and bladder) (1)(2)(3)(4). The cytotoxic effect of cisplatin is thought to be due to attack on DNA bases and induction of apoptosis in cancer cells (5,6).…”

Predicting response to neoadjuvant chemotherapy in patients with cervical carcinoma: can we do without any longer?

“…All patients were treated at Kalafong Academic Hospital, Pretoria, South Africa. The eligibility criteria, staging procedure, and chemotherapy regimen as well as the phase II results were reported previously (21) . The following clinico‐pathologic data were obtained for each patient: age (≤ 35 and > 35 years of age), histology (squamous cell carcinoma and tumors with an adenocarcinoma component), and grade of tumor differentiation.…”