Adjuvant Chemotherapy Does Not Improve Survival in Locally Advanced Cervical Cancer

By Andrew John, /alert Contributor
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Further chemotherapy following standard treatment failed to improve survival among patients with locally advanced cervical cancer, according to findings presented at the 2021 ASCO Annual Meeting.

“The study confirms that chemoradiotherapy alone is currently our best possible treatment for women with locally advanced cervical cancer,” Linda R. Mileshkin, MD, of the Peter McCallum Cancer Centre in Melbourne, Australia, said in a press release. “Not only is there no benefit with adjuvant chemotherapy, but severe side effects are also increased.”

Some oncologists use carboplatin and paclitaxel as adjuvant chemotherapy for locally advanced cervical cancer, although the news release from ASCO states that “until now, there has been no evidence from a large phase 3 study for or against the addition of chemotherapy in this setting.”

Mileshkin and colleagues performed a phase 3 trial of 919 patients with locally advanced cervical cancer. The researchers randomly assigned patients to receive either standard chemoradiotherapy, which consists of cisplatin and concurrent radiation (n = 456), or standard therapy plus adjuvant carboplatin and paclitaxel (n =  463). The main outcome was five-year overall survival. Secondary outcomes included disease recurrence, adverse events and progression-free survival.

Patients assigned to adjuvant therapy had a five-year overall survival of 72%, compared with 71% (HR = 0.91; 95% CI, 0.70-1.18) in the standard therapy group, the researchers reported. Progression-free survival was 63% in the adjuvant group, vs. 61% in standard care (HR = 0.87, 95% CI, 0.7-1.08). Both groups had similar rates of disease recurrence, Mileshkin and colleagues wrote.

Many (81%) patients in the adjuvant therapy group experienced grade 3 or higher adverse events, compared with 62% in the standard therapy group.

“This trial provides clear evidence that the addition of chemotherapy after chemoradiation does not extend survival. The results are immediately practice-changing, showing that this approach should not be used to treat locally advanced cervical cancer. We can now spare our patients the side effects and toxicity that comes with additional chemotherapy,” Lori J. Pierce, MD, FASTRO, FASCO, president of ASCO, said in the announcement.

Disclosures: Mileshkin reports no relevant financial disclosures. Please see the abstract for a complete list of all authors’ relevant financial disclosures. Pierce reports stock and other ownership interests with PFS Genomics and patents, royalties or other intellectual property with  PFS Genomics and UpToDate, as well as uncompensated relationships with Bristol-Myers Squibb and Exact Sciences.

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