A phase II study of weekly neoadjuvant chemotherapy followed by radical chemoradiation for locally advanced cervical cancer

M McCormack, L Kadalayil, A Hackshaw, M A Hall-Craggs, R P Symonds, V Warwick, H Simonds, I Fernando, M Hammond, L James, A Feeney, J A Ledermann, M McCormack, L Kadalayil, A Hackshaw, M A Hall-Craggs, R P Symonds, V Warwick, H Simonds, I Fernando, M Hammond, L James, A Feeney, J A Ledermann

Abstract

Background: We investigated the feasibility of dose-dense neoadjuvant chemotherapy (NACT) with paclitaxel and carboplatin before radical chemoradiation (CRT) and assessed the response rate to such a regimen.

Methods: CxII is a single-arm phase II trial of 46 patients, with locally advanced cervical cancer (stage Ib2-IVa). Patients received dose-dense carboplatin (AUC2) and paclitaxel (80 mg m⁻²) weekly for six cycles followed by CRT (40 mg m⁻² of weekly cisplatin, 50.4 Gy, 28 fractions plus brachytherapy). The primary end point was response rate 12 weeks post-CRT.

Results: Baseline characteristics were: median age at diagnosis 43 years; 72% squamous, 22% adenocarcinoma and 7% adenosquamous histologies; FIGO stage IB2 (11%), II (50%), III (33%), IV (7%). Complete or partial response rate was 70% (95% CI: 54-82) post-NACT and 85% (95% CI: 71-94) post-CRT. The median follow-up was 39.1 months. Overall and progression-free survivals at 3 years were 67% (95% CI: 51-79) and 68% (95% CI: 51-79), respectively. Grade 3/4 toxicities were 20% during NACT (11% haematological, 9% non-haematological) and 52% during CRT (haematological: 41%, non-haematological: 22%).

Conclusion: A good response rate is achieved by dose-dense weekly NACT with carboplatin and paclitaxel followed by radical CRT. This treatment regimen is feasible as evidenced by the acceptable toxicity of NACT and by the high compliance to radiotherapy (98%).

Figures

Figure 1
Figure 1
Kaplan–Meier plots for progression-free survival (PFS; upper) and overall survival (OS; lower) for the 46 patients in the study. The PFS and OS rates are the same for 3 and 5 years (68% and 67%) as there were no PFS or OS events between 3 and 5 years.

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Source: PubMed

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