Cervical cancer: Induction chemotherapy could improve survival by 39%

  • Recent improvements in cancer survival rates are partly due to improvements in treatments, as well as screening and prevention.
  • Efforts to improve cervical cancer survival have focused on screening for early detection and human papillomavirus (HPV) vaccination for prevention.
  • However, some people do still receive diagnoses of advanced cancer requiring treatment.
  • A recent study has shown that induction therapy could improve overall advanced cervical cancer survival rates by 39%.

Findings for a clinical trial started in 2012 to test the efficacy of induction therapy— a type of first-line chemotherapy treatment—in people with advanced cervical cancer were recently announced at the European Society for Medical Oncology (ESMO) congress on Sunday, October 22, 2023.

The trial results showed that induction therapy improved overall survival rates from advanced cervical cancer by as much as 39%.

The abstract for the INTERLACE phase III trial, funded by Cancer Research UK and UCL Cancer Trials Centre, was published in the Annals of Oncology.

Using induction chemotherapy for cervical cancer

Researchers recruited a cohort of 500 women with cervical cancer that was larger than 4 centimeters (cm) across (stage 1B2 to stage 4A), or 4 cm or less (stage 1B1 if the cancer is also in the lymph nodes) at centres in the U.K., Mexico, India, Italy, and Brazil.

They split this group into two arms, one of which received six weekly doses of carboplatin and paclitaxel chemotherapy before receiving up to 6 weeks of chemotherapy drug cisplatin and radiation therapy for their cancer.

The second arm of the study received just the standard six weeks of chemotherapy and radiation therapy for their cancer.

Lead author Dr Mary McCormack, a consultant clinical oncologist at University College London Hospitals NHS Trust in the U.K., where she is also the senior clinical oncologist in gynecological cancer, ​​told Medical News Today in an interview:

“We wanted to look at this approach. We wanted to see if we get some additional chemotherapy which can attack cancer cells. Will this reduce the risk of the cancer coming back in the lung and in the liver and in the lymph glands of the abdominal area. Will this reduce those risks of relapse?”

Researchers then followed up the cohort for five years, and found that patients who had received the induction chemotherapy had a significantly improved overall survival rate.

Those who had received induction therapy, chemotherapy, and radiotherapy had an overall survival rate at five years of 80%, compared to a 5-year survival rate of 72% of patients who had just the standard chemotherapy and radiotherapy.

This represented a 39% reduction in risk of death over five years in patients who received the induction therapy first.

What does progression-free survival mean?

Progression-free survival describes when people survive without their cancer growing or spreading.

Those who had received induction therapy, chemotherapy, and radiotherapy had a progression-free survival rate at five years of 73%, compared to a five progression-free survival rate of 64% of patients who had just the standard chemotherapy and radiotherapy. This represented a 35% reduction in risk of progression in the five years following treatment.

Side effects were greater in the group who had the induction chemotherapy, with 59% of that group experiencing side effects that interfered with their basic living ability, compared to 48% of the other group.

What is induction chemotherapy?

Cancer death rates have decreased by a third since 1991 in the United States, a 2023 report by the American Cancer Society (ACS) shows.

The ACS credits advances in early detection and treatment for the reduction in mortality seen in the U.S.

This decrease in mortality has been seen in other countries, too, with the National Health System in the United Kingdom noting an increase of 10% in cancer survival rates since 2005, earlier in 2023.

One development with treatment has been the introduction of induction chemotherapies. The National Cancer Institute defines induction therapy as “the first treatment given for a disease” before other treatments are given.

Induction chemotherapies are a form of chemotherapy given before other treatments to people with aggressive cancers at high risk of them spreading.

They have already been shown to be effective at improving overall survival rates for breast cancer, lung cancer, acute myeloid leukemia, and pancreatic cancer, among others. These treatments may be followed with further chemotherapy, surgery, or radiotherapy.

Next step: Incorporating induction chemotherapy into official guidelines

The study authors said these results were sufficient to justify recommending treatment with induction therapy, and they suggested it should be included in standard care for this group of cervical cancer patients.

They also pointed to the five countries the trial was conducted in, demonstrating that it is feasible to offer this treatment in many different healthcare systems.

Next, Dr. McCormack said she wanted to ensure the guidelines for cervical cancer treatment were changed to reflect the findings.

“[T]he next thing is to get this induction chemotherapy to have it incorporated into the guidelines for treating cervical cancer and obviously also to empower women to ask their doctors about it. [T]his is cheap, readily available treatment and it could potentially be incorporated into clinical guidelines very quickly,“ she told MNT.

“Obviously, we want to write our paper and publish this in a peer-reviewed journal, but it doesn’t have to wait for any particular approvals by governments,” Dr. McCormack added.

Increasing survival from cervical cancer

Dr. Elena Pereira, a gynecologic oncologist at Northwell Health, NY, who was not involved in the study, told MNT in an interview that the findings were clinically meaningful.

“I think the difference in survival is meaningful. And while it’s a very bold statement to say that these findings are practice-changing, I really do think they have the potential to change how we approach at least locally advanced tumors.”
— Dr. Elena Pereira

However, she added that more data is needed to be published from the trial before clinicians could base decisions on these results.

“[A]s a clinician, it’s important to have all the information which they’re not able to share an abstract form, so without having full publication available yet, I would most like to say it has the potential to practice changing,” she said.

How to prevent cervical cancer

Dr. McCormack also made the point that cervical cancer is a highly avoidable cancer. The HPV vaccine was introduced first to adolescent girls in 2006 and then to boys before they become sexually active to help prevent infection and subsequent development of cervical cancer.

Cervical cancer rates in people in their 20s decreased by 65% between 2012 and 2019 in the U.S. Researchers believe this decrease is due to the introduction of the HPV vaccine in 2006 and “foreshadows” a further decrease in cervical cancer rates there.

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