New standard of care for patients with locally advanced cervical cancer

Abstract

A short course of induction chemotherapy delivered immediately before chemoradiotherapy significantly improved progression-free survival and overall survival for patients with locally advanced cervical cancer in comparison with the current standard of care with chemoradiotherapy alone, according to the results of the INTERLACE trial published in The Lancet.¹

At a median follow-up of 67 months, the 5-year overall survival rates were 80% for patients treated with induction chemotherapy followed by chemoradiotherapy and 72% for patients treated with chemoradiotherapy alone, whereas the 5-year progression-free survival rates were 72% and 64%, respectively. Overall, patients who received induction therapy had a 38% lower risk of disease progression and a 40% lower risk of death than those treated with chemoradiotherapy alone.

The findings indicate a new standard of care for these patients according to the study authors, who were led by Mary McCormack, MD, a consultant clinical oncologist at the University College Hospitals NHS Trust in London.

Of critical importance is the timing of chemoradiotherapy after induction therapy to avoid any gaps in treatment. Up to 93% of patients in the study who received induction chemotherapy received it 14 days or less before chemoradiotherapy. Dr McCormack underscores the importance of ensuring that patients proceed to chemoradiotherapy immediately after induction chemotherapy (i.e., induction chemotherapy is delivered in Weeks 1–6 and is followed by radiotherapy plus cisplatin, including brachytherapy, in Weeks 7–13).

Dr McCormack stresses that induction chemotherapy did not compromise the delivery of definitive radiation, with 96% of the patients who were treated with induction chemotherapy completing the course of definitive radiation within 56 days. Prior evidence shows a higher tumor control probability when the overall radiation treatment time is less than 56 days.²

She says that radiotherapy, particularly in under-resourced settings, should be scheduled before induction chemotherapy is initiated, and she emphasizes that “the induction chemotherapy approach is not designed to manage radiotherapy wait times.”

INTERLACE is a multinational, phase 3 trial of 500 patients with locally advanced cervical cancer randomized to standard cisplatin-based chemoradiotherapy alone (n = 250) or induction chemotherapy (carboplatin and paclitaxel) followed by chemoradiotherapy (n = 250).

Commenting on the study, Elise Kohn, MD, head of Gynecologic Cancer Therapeutics in the Cancer Therapy Evaluation Program at the National Cancer Institute, agrees that the results of the study could translate into a change in practice for treating patients with early-stage cervical cancer. As with all treatments, she emphasizes that practitioners should assess patients for signs, symptoms, and risks of this approach and engage in shared decision-making to allow patients to participate in their treatment plan and raise any concerns.

Given that hematologic toxicity, mainly neutropenia, was more common during chemoradiotherapy in patients who first received induction chemotherapy, Dr McCormack emphasizes the importance of closely monitoring patients during induction chemotherapy for hematologic toxicity and initiating treatment with growth factors when indicated.