Researchers have found that a short course of induction chemotherapy prior to chemoradiation may be effective at reducing the rate of relapse and mortality among patients with locally advanced cervical cancer, according to new preliminary findings presented by McCormack et al at the European Society for Medical Oncology (ESMO) Congress 2023 (Abstract LBA8).
Background
Patients in their early 30s may have the highest risk of developing cervical cancer, with about 3,200 new cases reported each year in the United Kingdom and a 5-year survival rate of 70%. Chemoradiation has been the standard treatment for cervical cancer since 1999; however, despite improvements in radiation therapy techniques, up to 30% of patients can experience cancer recurrence.
“[Patients] with locally advanced [cervical cancer] have a relatively high [risk] of relapse, and the disease can take a huge toll on patients and their families,” explained senior study author Jonathan Ledermann, MD, of the University College London Cancer Institute.
“Timing is everything when you’re treating cancer,” emphasized Iain Foulkes, PhD, Executive Director of Research and Innovation at Cancer Research UK. “A growing body of evidence is showing the value of additional rounds of chemotherapy before other treatments like surgery and radiotherapy in several other cancer [types]. Not only can it reduce the chances of cancer coming back, it can be delivered quickly using drugs already available worldwide,” he added.
Study Methods and Results
In the new phase III INTERLACE trial, researchers randomly assigned 500 patients with a median age of 46 years who had cervical cancer that was large enough to be detected without a microscope but that had not yet metastasized to receive either an initial 6-week course of induction chemotherapy with carboplatin and paclitaxel followed by standard chemoradiation (external radiation with weekly cisplatin and brachytherapy) or standard chemoradiation alone.
After a follow-up of 5 years, the researchers found that the patients in the combination therapy group had a survival rate of 80% and those in the chemoradiation alone group had a survival rate of 72%. Further, 73% of the patients who received induction chemotherapy and chemoradiation did not experience cancer recurrence or metastasis vs 64% of those who received chemoradiation alone.
Conclusions
“Our trial shows that this short course of additional chemotherapy delivered immediately before the standard [chemoradiation] can reduce the risk of the cancer returning or death by 35%,” highlighted lead study author Mary McCormack, PhD, of the University College London Cancer Institute and the University College London Hospitals. “This is the biggest improvement in outcome in this disease in over 20 years. I’m incredibly proud of all the patients who participated in the trial; their contribution has allowed us to gather the evidence needed to improve treatment of [patients with] cervical cancer everywhere. We couldn’t have done this without the generous support of Cancer Research UK,” she added.
Because the drugs required for induction chemotherapy are often affordable, accessible, and already approved for use in patients, the researchers noted that the drugs can be incorporated into standard care relatively quickly.
“The simple act of adding induction chemotherapy to the start of chemoradiation treatment for cervical cancer has delivered remarkable results in this trial,” Dr. Foulkes underscored. “We’re excited for the improvements this trial could bring to cervical cancer treatment and hope short courses of induction chemotherapy will be rapidly adopted in the clinic,” he concluded.
Disclosure: The research in this trial was funded by Cancer Research UK and the University College London Cancer Trials Centre.
