Prognostic factors for response to cisplatin-based chemotherapy in advanced cervical carcinoma: A Gynecologic Oncology Group Study

Abstract

Purpose Cisplatin-based combination chemotherapy is considered standard treatment for advanced/recurrent cervical carcinoma; however, the majority of patients do not respond. This study was undertaken to identify the prognostic factors and develop a model predictive of (non-) response to chemotherapy. Methods Four-hundred twenty-eight patients with advanced cervical cancer who received a cisplatin-containing combination in three Gynecologic Oncology Group (GOG) protocols (110, 169 and 179) were evaluated for baseline clinical characteristics and multivariate analysis was conducted to identify factors independently prognostic predictive of response using a Logistic regression model. A predictive model was developed and externally validated using an independent GOG protocol (149) data. Results Multivariate analysis identified five factors (African-American, performance status [PS] > 0, pelvic disease, prior radiosensitizer and time interval from diagnosis to first recurrence ≤ one year) independently prognostic of poor response. A simple prognostic index was derived based on the total number of risk factors. When patients were classified into three risk groups (low risk: 0–1 factor; mid risk: 2–3 factors; high risk: 4–5 factors), patients with 4–5 risk factors were estimated to have a response rate of only 13%, and median progression-free and overall survival of 2.8 months and 5.5 months, respectively. The accuracy of the index was supported by both internal and external datasets. Conclusions A simple index based on five prognostic factors may have utility in clinical practice to identify the women who are not likely to respond to the cisplatin-containing regimens. This subgroup of patients should be considered for non-cisplatin chemotherapy or investigational trials.

Integration of bevacizumab with chemotherapy doublets for advanced cervical cancer

“…This represents valuable time that may allow patients to receive other promising novel therapies including other types of angiogenesis treatment or immunotherapy to take advantage of what the forefront of translational research has to offer. Additionally in GOG 240, validation of the Moore criteria for identification of patients with poor prognostic factors not likely to respond to cisplatin-based regimens demonstrated that the highest risk patients benefit the most from angiogenesis inhibition with bevacizumab [31,32].…”

Survival Outcomes of Advanced and Recurrent Cervical Cancer Patients Treated with Chemotherapy: Experience of Northern Tertiary Care Hospital in Thailand

“…Moore et al (Moore et al, 2010 ) reported five independent prognostic factors for survival outcomes of cisplatin-based chemotherapy in 428 advanced cervical cancer patients from three GOG protocols (GOG 110,169 and 179). These factors included African-American, performance status more than zero, pelvic disease, prior radiotherapy, and time interval from diagnosis to first recurrence less than 12 months.…”

Carboplatin and paclitaxel as an initial treatment in patients with stage IVb cervical cancer: a report of 7 cases and a review of the literature

“…9 A recent retrospective review of four randomized phase III GOG clinical trials suggested that advanced or recurrent cervical cancer patients who had been previously treated with radiosensitizing-cisplatin showed poorer response to platinum-based chemotherapy than those who had not. 10 With the aim to investigate the effectiveness of non-platinum containing chemotherapy in the same population, GOG has recently initiated a phase III trial (protocol 240) comparing TP versus non-platinum doublet (paclitaxel-topotecan), with or without bevacizumab.…”