A comparative study of the effectiveness of multiagent platinum based concurrent plus adjuvant versus conventional single agent platinum based concurrent chemotherapy in carcinoma cervix.

Authors

null

Salman Khurshid Shah

Vydehi Institute of Medical Sciences and Research Centre, Karnataka, India

Organizations

Vydehi Institute of Medical Sciences and Research Centre, Karnataka, India

Research Funding

No funding received
None.

Background: Cervical cancer is the 4th most common cancer in females worldwide. Combination of external beam radiotherapy (EBRT) and intracavitary brachytherapy (BT) with concurrent chemotherapy is the current standard of care for locally advanced cervical cancer. Even though the trials used separate combinations, the common end point suggested that platinum is single most effective chemotherapy agent. Since the latest data on platinum based polychemotherapy globally indicates its overall benefit, further trials are required to determine what regimens would be ideal for treatment of cervical cancer with maximum benefits and least toxicities. Objectives: 1. To compare the response to doublet polychemotherapy with conventional chemotherapy in carcinoma cervix treated with chemoradiation. 2. To compare toxicity profile of doublet polychemotherapy with conventional chemotherapy. Methods: 66 patients of carcinoma cervix were enrolled in this study and were randomized to two arms. Arm A (n=34) was the experimental arm and the patients received concurrent weekly cycles of cisplatin(40mg/m2) plus gemcitabine (125mg/m2) along with EBRT followed by HDR brachytherapy, after 2-3 weeks of which they received 2 adjuvant cycles (21 days each) of gemcitabine (1000mg/m2 on Day1 and Day 8) and cisplatin (50mg/m2 on Day 1). Arm B(n=32) was the control arm and the patients received standard treatment which is concurrent weekly cycles single agent cisplatin(40mg/m2) with EBRT followed by HDR brachytherapy. EBRT doses ranged from 45Gy to 50.4 Gy at 1.8 to 2 Gy per fraction .BT application was either ICBT or ISBT depending on tumour response to EBRT, assessed by MRI. Patients were followed up for response assessment and late toxicities within 6 months of completion of treatment by clinical examination and MRI which was reported using RECIST 1.1 criteria. Results: On 6 month follow up MRI, number of patients achieving CR was 10% higher in the experimental arm (Arm A, n=33;97.06%) than the control arm (Arm B, n=28;87.5%).PR was seen in 2 patients, both from Arm B. Of the 3 patients presenting with PD at follow up 1 belonged to Arm A and 2 to Arm B (2.94% vs 6.25%). On pre-brachytherapy MRIs, the size reduction was better in Arm A and this reduction allowed a majority of patients in said arm to undergo ICBT instead of ISBT. The number of patients achieving >50% reduction post EBRT was 40% higher in Arm A. Acute GI and Hematological toxicities were seen in both arms but were higher in Arm A. as was Grade 3 neutropenia. Late toxicities were similar in both arms. Conclusions: The study concluded that the use of multiagent platinum-based chemotherapy in concurrent plus adjuvant setting can be advantageous. Improved tumour reduction can be achieved & disease can be made more amenable for ICBT. The accompanying toxicities were transient and clinically manageable.

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Abstract Details

Meeting

2023 ASCO Breakthrough

Session Type

Poster Session

Session Title

Poster Session B

Track

Gastrointestinal Cancer,Gynecologic Cancer,Head and Neck Cancer,Quality of Care,Genetics/Genomics/Multiomics,Healthcare Equity and Access to Care,Healthtech Innovations,Models of Care and Care Delivery,Population Health,Viral-Mediated Malignancies

Sub Track

Multimodality Treatments

Citation

JCO Global Oncology 9, 2023 (suppl 1; abstr 85)

DOI

10.1200/GO.2023.9.Supplement_1.85

Abstract #

85

Poster Bd #

E2

Abstract Disclosures