Chemoradiation With Paclitaxel and Carboplatin in High-Risk Cervical Cancer Patients After Radical Hysterectomy: A Korean Gynecologic Oncology Group Study

Lee, Taek Sang; Kang, Soon Beom; Kim, Young Tak; Park, Byung Joo; Kim, Yong Man; Lee, Jong Min; Kim, Seok Mo; Kim, Young Tae; Kim, Jae Hoon; Kim, Kyung Tai

doi:10.1016/j.ijrobp.2013.01.035

Cited by 16 publications

(8 citation statements)

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“…In our study, the first to third administration of taxanes caused severe anaphylaxis whereas fourth‐ or latter‐infusion did not, and most of these taxanes‐induced severe anaphylaxes occurred within 5 min. These findings consistent with those of previous studies regarding hypersensitivity of any grade 8,14 . Although some researchers mentioned that paclitaxel hypersensitivity is milder than that caused by carboplatin, 5 we should do recognize that paclitaxel‐induced severe anaphylaxis is not rare (Table 3).…”

Section: Discussionsupporting

confidence: 90%

Severe anaphylaxis caused by intravenous anti‐cancer drugs

et al. 2021

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Background The incidence and risk factors of severe anaphylaxis by intravenous anti‐cancer drugs are unclear, whereas those of milder reactions have been reported. Study Design Electronic medical charts of cancer patients who have undergone intravenous chemotherapy between January 2013 and October 2020 in a university hospital were retrospectively reviewed. Non‐epithelial malignancies were also included in the analysis. "Severe anaphylaxis" was judged using Brown's criteria: typical presentation of anaphylaxis and one or more of hypoxia, shock, and neurologic compromise. (UMIN000042887). Results Among 5584 patients (2964 males [53.1%], 2620 females [46.9%], median age 66 years), 88,200 person‐day anti‐cancer drug administrations were performed intravenously, and 27 severe anaphylaxes were observed. The causative drugs included carboplatin (14 cases), paclitaxel (9 cases), and cisplatin, docetaxel, trastuzumab, and cetuximab (1 case each). The person‐based lifetime incidence of severe anaphylaxis for patients who received at least one intravenous chemotherapy was 0.48% (27/5584, 95% confidence interval (CI) 0.30%–0.67%) and the administration‐based incidence was 0.031% (27/88,200, 95% CI 0.019%–0.043%). Among 124 patients who received at least 10 carboplatin administrations, 10 patients experienced carboplatin‐induced severe anaphylaxis (10/124, 8.1%, 95% CI 3.0%–13.1%). Carboplatin caused severe anaphylaxis after at least 9‐min interval since the drip started. Thirteen out of 14 patients experienced carboplatin‐induced severe anaphylaxis within a 75‐day interval from the previous treatment. Paclitaxel infusion caused severe anaphylaxis after a median of 5 min after the first drip of the day at a life‐long incidence of 0.93% (9/968, 95% CI 0.27%–1.59%). Conclusion We elucidated the high‐risk settings of chemotherapy‐induced severe anaphylaxis.

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Section: Discussionsupporting

confidence: 90%

Severe anaphylaxis caused by intravenous anti‐cancer drugs

et al. 2021

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“…In addition, Lee et al . showed that paclitaxel (at 135 mg/m 2 ) plus carboplatin (area under the curve = 5) every three weeks for three cycles concomitant with RT as adjuvant therapy for patients with high‐risk factors was well tolerated and the estimated five‐year disease‐free survival and OS rates were 77.3% and 80.3%, respectively, in their phase II trial …”

Section: Treatment For Patients With High‐risk Factors After Radical mentioning

confidence: 99%

The issues regarding postoperative adjuvant therapy and prognostic risk factors for patients with stage I–II cervical cancer: A review

Takekuma

Kasamatsu

Kado

et al. 2017

J of Obstet and Gynaecol

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The treatment for most patients with early-stage cervical cancer involves radical hysterectomy and pelvic lymph node dissection, and indications for postoperative adjuvant therapy have been determined by evaluating the prognostic risk factors for recurrence in each case. The aim of this review is to raise and discuss the various issues that have not yet been resolved regarding the prognostic risk factors and postoperative adjuvant therapy. Several clinicopathological factors, such as tumor size, lymphovascular space involvement, deep stromal invasion, parametrial involvement and lymph node metastasis, have been identified to have prognostic significance in early-stage cervical cancer. However, this remains controversial because there is suggested to be substantial heterogeneity among patients after radical hysterectomy and lymphadenectomy and it would be difficult to define the risk groups clearly. This indicates the need to develop more convenient and accurate criteria to define risk groups. According to the currently available evidence, patients in the high-risk group should receive adjuvant concurrent chemoradiotherapy (CCRT) with cisplatin (CDDP) and fluolouracil. However, CCRT with CDDP administered weekly (CCRT-P) has instead been applied in a clinical context worldwide. Whether CCRT-P has a survival benefit compared with radiotherapy (RT) alone is unknown because no randomized phase III trials have been performed for patients in the high-risk group after radical surgery. Patients with high-risk factors have a high incidence of distant metastasis, for whom systemic chemotherapy might be a key to improving overall survival. The pivotal study that investigated the role of RT alone for patients with intermediate-risk factors after hysterectomy is the GOG092 trial. This trial showed a 47% reduction in the risk of recurrence after RT compared with no further treatment (NFT). However, the improvement in overall survival with RT did not reach statistical significance, while patients allocated to the RT group did experience an increase in severe toxicities compared with the NFT group. This could be why many physicians are reluctant to treat patients with this approach, although guidelines recommend RT for patients with intermediate-risk factors. With regard to toxicities, postoperative RT would be problematic because the organs in the pelvis targeted by RT have already been damaged by radical surgery. To reduce the toxicities, intensity-modulated radiotherapy would best be used worldwide. Further improvement in adjuvant therapy will come from enhanced definition of prognostic risk factors, better patient selection, and refinements in both local and systematic therapies.

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“…The number of lymphatic vessels within the tumor relates to tumor lymphatic metastasis. It was considered that malignant tumor is able to induce lymphangion genesis within the tumor and is related to tumor lymphatic metastasis [16]. Balsat and others have detected LVD marked by FHIT in tissue in 41 cases of cervical cancer and 12 cases of normal cervix and found that lymphatic vessels are observed within and around the tumor tissue and LVD is significantly higher than that of a normal cervix, which relates to lymph node metastasis and lymphatic vessel infiltration of cervical cancer, indicating that lymphatic vessels both within and around the tumor tissue play a vital role in lymph node metastasis of tumour cells [17].…”

Section: Discussionmentioning

confidence: 99%