Neoadjuvant chemotherapy in cervical cancer: an update

Abstract

The role of neoadjuvant chemotherapy (NACT) has been investigated in order to improve prognosis of patients with locally advanced cervical cancer. According to a meta-analysis, NACT followed by radiotherapy may be detrimental with a low dose of cisplatin and longer cycle intervals. Some meta-analyses showed NACT followed by surgery resulted in a reduction in the risk of death by 35% with a gain of 14% in the 5-year survival compared with radiotherapy. In a Cochrane meta-analysis, overall survival and progression-free survival were significantly improved with NACT followed by surgery versus surgery alone (23% reduction in the risk of death). The platinum/paclitaxel combination is now the preferred regimen in the neoadjuvant setting and preliminary data indicate that dose-dense regimens are feasible and effective (overall response rate: 67.8–87%). A weekly regimen with carboplatin/paclitaxel before chemoradiation showed promising results and the INTERLACE ongoing trial will help to confirm whether additional short-course chemotherapy given weekly before chemoradiation will lead to an improvement in overall survival.

Keywords:

• emerging therapies
• locally advanced cervical cancer
• neoadjuvant chemotherapy
• radiotherapy
• surgery

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Cervical cancer is a chemo-responsive tumor.

• Neoadjuvant chemotherapy before surgery improves survival over radiotherapy.

• Neoadjuvant chemotherapy before surgery improves survival over surgery.

• Neoadjuvant chemotherapy before radiotherapy does not improve outcome: possible detrimental effect with the use of prolonged interval and lower cisplatin dose.

• Optimal regimen to use in the neoadjuvant setting is not yet established.

• Promising preliminary results with dose-dense regimens.