Carboplatin/paclitaxel induction chemotherapy, directly followed by standard chemoradiotherapy, improved survival in locally advanced cervical cancer.
For more than 2 decades, chemoradiotherapy has been the standard of care for patients with locally advanced cervical cancer (FIGO IB3-IVA). Although local control of disease has increased over time, up to 30% of patients eventually relapse and die from metastatic disease.
Until now, the use of induction chemotherapy has not proven beneficial. A recent phase 2 study showed the feasibility and a good response rate of induction chemotherapy using weekly paclitaxel and carboplatin for 6 cycles, immediately followed by standard chemoradiotherapy.1 The current phase 3 INTERLACE trial (EudraCT: 2011-001300-35) randomized 500 participants with locally advanced cervical cancer (stage IB1 node positive-IVA) to standard chemoradiotherapy or induction chemotherapy followed by standard chemoradiotherapy. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Results were presented by Dr. Mary McCormack of University College London.2
About 75% of enrolled participants presented with stage IIA or IIB disease, 82% showed squamous histology, and almost 60% of participants and tumors were node-negative. Adherence to induction chemotherapy was high, with more than 90% of participants having received at least 5 cycles of induction chemotherapy. In addition, more than 90% of participants adhered to radiotherapy in both study arms.
Induction chemotherapy substantially increased both PFS and OS. At the 5-year follow-up, 73% of participants in the induction arm were progression-free versus 64% in the control arm (HR, 0.65; 95% CI, 0.46-0.91; P=.013). At the same follow-up time point, 86% of participants in the induction arm were still alive versus 80% in the control arm (HR 0.61; 95% CI 0.40-0.91; P=.04). “OS in the control arm was similar to that in the recent literature,” remarked Dr. McCormack. Total local relapse rates after 5 years were 16% in both arms. In contrast, the total distant relapse rate after 5 years was 12% in the induction arm versus 20% in the control arm.
“In conclusion, the INTERLACE trial showed that short induction chemotherapy with paclitaxel and carboplatin can significantly improve PFS and OS and decrease distant relapses. This induction protocol is feasible across different healthcare settings and should be considered the new standard in locally advanced cervical cancer,” summarized Dr. McCormack.
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