Comparison of platinum monotherapy with concurrent chemoradiation therapy versus platinum-based dual drug therapy with concurrent chemoradiation therapy for locally advanced cervical cancer: a systematic review and meta-analysis

Abstract

Objective To compare the survival outcomes and adverse events of patients with locally advanced cervical cancer (LACC) who received platinum monotherapy with concurrent chemoradiation therapy (CCRT) versus platinum-based dual drug therapy with CCRT. Method All relevant literature was screened form the PubMed, EMBASE, Web of Science, The Cochrane Library and other databases from their establishment to October 2020. The main endpoint indicators included overall survival (OS) and progression-free survival (PFS). Grade 3 and above adverse events induced by chemotherapy were also compared. Results This study involved 17 literature and 4,106 patients. There were 2,066 patients treated with CCRT with platinum-based dual drug therapy and 2,040 patients received CCRT with platinum monotherapy. Meta-analysis results showed that, compared to CCRT with platinum monotherapy, OS (HR = 0.68, 95% CI 0.58–0.79) and PFS (HR = 0.67, 95% CI 0.58–0.77) of LACC patients were significantly improved by CCRT with platinum-based dual drug therapy. In addition, CCRT with platinum-based dual drug therapy led to more adverse reactions such as neutropenia (OR = 4.92, 95% CI 3.55–6.84), anemia (OR = 1.99, 95% CI 1.17–3.39), diarrhea (OR = 1.70, 95% CI 1.30–2.22), leukopenia (OR = 2.42, 95%CI 1.84–3.17), thrombocytopenia (OR = 2.87, 95%CI 1.44–5.72), etc. Conclusion CCRT with platinum-based dual drug therapy improved OS and PFS of LACC patients relative to the CCRT with platinum monotherapy. But it also increased the adverse reactions caused by multiple chemotherapy drugs. Thus, it is crucial to select a proper chemotherapy regimen based on the actual tolerance of patients in clinical practice.

Paclitaxel Aggravating Radiation-Induced Pulmonary Fibrosis Is Associated with the Down-Regulation of the Negative Regulatory Function of Spry2

“…Therefore, PTX is often administered concurrently with radiotherapy to exert a synergistic anti-tumor effect, which however may aggravate the damage to normal tissues caused by radiotherapy. Clinical cases (Zhang et al, 2007;Dai et al, 2011) as well as our study have shown that PTX can aggravate RIPF, the damage to normal lung tissue from thoracic irradiation. In light of the observation that ERK is the main signaling pathway that promotes FBs activating into more vigorous myofibroblasts (Foglia et al, 2019;Ng et al, 2019;Wu et al, 2020), and that PTX can up-regulate ERK activity (Seidman et al, 2001;Huang et al, 2019a), also with the findings that overexpression of Spry2 can abolish PTX-induced c-Raf activation (Ahn et al, 2010), we explored the mechanism by which PTX aggravates RIPF.…”

Can laparoscopic nerve-sparing ultra-radical hysterectomy play a role in locally advanced cervical cancer? A single-center retrospective study

“…Therefore, in clinical practice, it is extremely important to select the appropriate chemotherapy scheme in accordance with the patient’s actual tolerance. Therefore, the choice of LACC treatment remains a huge problem in the currently available treatment - modalities ( 32 ).…”

The Influence of Patient and System Factors on the Radiotherapy Treatment Time in the Treatment of Non-metastatic Cervical Cancer Patients in a Rural and Resource-Lean State’s Safety-Net Hospital: Benefits of Strategic Planning

“…For those patients not tolerating cisplatin chemotherapy, carboplatin can be a good substitute [ 8 ]; an alternative regimen among those patients intolerant of cisplatin is a combination of cisplatin plus fluorouracil given every three to four weeks can be considered [ 8 , 9 ]. The role of a combination of cisplatin plus gemcitabine is still evolving [ 10 , 11 ]. The role of targeted therapy and precision therapy/radiobiotherapy in the future needs to be defined and likely to improve the outcomes [ 12 , 13 ].…”