1. 5-year progression-free survival was increased in the induction chemotherapy group compared to standard chemoradiotherapy.

2. Patients in the induction chemotherapy group reported more frequent grade 3 or greater adverse events.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Locally advanced cervical cancer is typically treated with chemoradiotherapy. However, many patients continue to undergo relapse and death from metastatic disease. This randomized controlled trial aimed to assess whether induction chemotherapy, followed by standard chemoradiotherapy, improves both progression-free survival and overall survival in patients with locally advanced cervical cancer. The primary outcome of this study was progression-free survival, while the key secondary outcome was overall survival. According to study results, patients who received induction chemotherapy had improved five-year progression-free survival and overall survival rates. Although this study was well done, it was limited by an increased rate of adverse events in the induction chemotherapy group.

Click to read the study in The Lancet

Relevant Reading: Tisotumab Vedotin as Second- or Third-Line Therapy for Recurrent Cervical Cancer

In-depth [randomized-controlled trial]: Between Nov 8, 2012, and Nov 17, 2022, 1493 patients were screened for eligibility from 32 medical centers in Brazil, India, Italy, Mexico, and the UK. Included were patients ≥ 18 years with locally advanced cervical cancer (FIGO 2008 stages IB1 to IVA). Altogether, 500 patients (250 to chemoradiotherapy and 250 to induction chemotherapy followed by chemoradiotherapy) were included in the final analysis. The primary outcome of 5-year progression-free survival was increased in the induction chemotherapy group compared to chemoradiotherapy-alone (72% vs. 64%, hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.46-0.91, p=0.013). The secondary outcome of overall survival showed a similar trend (80% induction chemotherapy vs. 72% chemoradiotherapy, HR 0.60, 95% CI 0.40-0.91, p=0.015). Findings from this study suggest that adding induction chemotherapy to standard chemoradiotherapy may improve survival outcomes for patients with locally advanced cervical cancer.

Image: PD

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