Biggest cervical cancer drug advance in 20 years

Five-year survival odds improve when women receive so-called induction chemotherapy before their standard treatment regimen, a new study suggests

ANALYSIS | AGENCIES | Giving chemotherapy to patients with locally advanced cervical cancer (LACC) before their standard treatment regimen boosts their five-year survival odds by 39 percent, a new study finds.

“This is the biggest improvement in outcome in this disease in over 20 years,” said lead study author Mary McCormack, MBBS, an oncologist at University College London Hospital and Cancer Institute, in a statement.

The new regimen, given once a week in the build-up to CRT, should be considered a “new standard of care” and is “feasible across diverse healthcare settings,” according to Dr McCormack, who presented the results at the European Society of Medical Oncology (ESMO) Congress in Madrid, Spain.

“The results are encouraging for a disease that for several decades has failed to show improvements in long-term outcomes beyond those achieved with CRT alone and that has a high unmet need for new treatments,” said Prof. Ana Oaknin of the Hospital Universitari Vall d’Hebron in Spain.

Many women who do not get regular screening for cervical cancer are not diagnosed until tumors have become too large or spread too far to be treated with surgery. According to the National Cancer Institute, while five-year survival rates are about 90 percent for cases caught sooner when surgery is still possible, survival odds are much lower for people with these larger tumors and locally advanced cancers.

According to the American Cancer Society, locally advanced means that the cancer has spread beyond the part of the body it began in, but has not yet reached other organs.

Improved Survival Rates

For the new study, researchers gave 500 women with locally advanced cervical cancer five weekly cycles of the chemotherapy drug cisplatin combined with radiation, currently standard care.

Before starting this regimen, half of the women were randomly assigned to receive six weeks of so-called induction chemotherapy treatment with two drugs, carboplatin and paclitaxel.

With induction chemotherapy, 80 percent of patients survived five years, compared with 72 percent in the group that only received standard care, according to study results published in the Annals of Oncology.

“The improvement in response to getting chemotherapy before radiation is significant and may be reflective of the ease of starting treatment,” says Angela Jain, MD, an assistant professor at the Fox Chase Cancer Center in Philadelphia, who wasn’t involved in the new study.

Standard treatment slow

Standard treatment with chemotherapy and radiation typically takes a few weeks to start after patients have an initial meeting with an oncologist, Dr. Jain says. But if patients receive induction chemotherapy before this standard treatment regimen, they can likely begin treatment within a week of that initial visit.

Based on the study results, induction chemotherapy “is absolutely a treatment that we can start discussing with our patients with a new diagnosis now,” Jain says.

In addition to improving survival odds, induction chemotherapy also made it more likely that patients would survive five years without tumor growth. With induction chemotherapy, 73 percent of patients had no tumor growth by the end of the study, compared with 64 percent of women who received only standard care.

Results nor for all

One limitation of the study is that the majority of patients were from the United Kingdom and it’s possible that results would differ in other countries or for people from other racial or ethnic backgrounds.

Another drawback is that more than half of the patients in the study had locally advanced tumors that had not spread to surrounding lymph nodes, also known as node-negative disease, according to a statement from Ana Oaknin, MD, PhD, of Hospital Universitari Vall d’Hebron in Barcelona, Spain.

“It is important to consider the population recruited and the large proportion of patients — 58 percent — who had node-negative disease, as we know that positive lymph nodes are indicative of a high risk of relapse,” said Dr. Oaknin, who was not involved in the new study.

Still, there is an urgent need for better treatments for cervical cancer, and the study results suggest that induction chemotherapy may be a promising option, per another statement from Krishnansu Tewari, MD, director of the gynecologic oncology program at the University of California in Irvine.

“Standard treatment does lead to remission, but within two to three years the cancer can come back,” Dr. Tewari said. “Induction chemotherapy could be an accessible treatment option because these drugs are available around the world, including in low-resource countries.”