Dose-Intense Cisplatin-Based Neoadjuvant Chemotherapy Increases Survival in Advanced Cervical Cancer: An Up-to-Date Meta-Analysis

Abstract

Purpose: We set out to demonstrate the benefit of using dose-intense cisplatin-based neoadjuvant chemotherapy in terms of overall survival and progression-free survival. Methods: We searched through MEDLINE and Cochrane Library databases up to May 2021 to identify randomized clinical trials comparing the benefit of using cisplatin-based neoadjuvant chemotherapy followed by local treatment with local treatment alone for the treatment of locally advanced cervical cancer. The PRISMA statement was applied. Results: Twenty-two randomized clinical trials were retrieved between 1991 and 2019, corresponding to 3632 women with FIGO stages IB2-IVA cervical cancer. More than 50% of the randomized clinical trials were assessed as having a low risk of bias. There was no benefit of neoadjuvant chemotherapy on overall survival, but there was significant heterogeneity across studies (I2 = 45%, p = 0.01). In contrast, dose-intense cisplatin at over 72.5 mg/m2/3 weeks was significantly associated with increased overall survival (RR = 0.87, p < 0.05) with no heterogeneity across the pooled studies (I2 = 36%, p = 0.11). The survival benefit was even greater when cisplatin was administered at a dose over 105 mg/m2/3 weeks (RR = 0.79, p < 0.05). Conclusion: Even though radiotherapy combined with weekly cisplatin-based chemotherapy remains standard of care for the treatment of locally advanced cervical cancer, our meta-analysis makes it possible to consider the use of dose-intense cisplatin-based neoadjuvant chemotherapy when local treatment is suboptimal and opens perspectives for designing new clinical trials in this setting. Neoadjuvant chemotherapy could be proposed when surgery is local treatment instead of standard chemoradiotherapy for the treatment of locally advanced cervical cancer.

Fyn expression is associated with the response of patients with locally advanced uterine cervical squamous cell carcinoma to neoadjuvant chemotherapy

“…NAC followed by surgery is considered the standard treatment option for patients with locally advanced uterine cervical cancer, and there are numerous studies revealing the effectiveness of NAC for patients with locally advanced uterine cervical cancer. Nguyen et al (5) performed a meta-analysis that showed that dose-intense cisplatin-based NAC followed by surgery increases survival in stage IB2-IVA uterine cervical cancer patients. Mori et al (14) reported that NAC using paclitaxel and carboplatin followed by surgery was a promising mode of therapy for stage IB2-IIIB uterine cervical cancer patients with a good probability of improving the prognosis.…”

“…Neoadjuvant chemotherapy (NAC) followed by surgery is considered one of the treatment options for patients with locally advanced uterine cervical cancer, even though its value remains contested. NAC has the potential to reduce the tumor size and allow for a hysterectomy for patients with stages IIIB-IVA uterine cancer in which hysterectomy is normally not possible, and this course can improve a patient's prognosis (4)(5)(6). However, if the NAC treatment does not effectively shrink the tumor size, the patients instead have to undergo radiotherapy, and this delays the initiation of the core treatment, and thus a worse prognosis.…”

Promising predictive molecular biomarkers for cervical cancer (Review)

“…Platinum-based neoadjuvant chemotherapy (NACT) before radical hysterectomy or radiotherapy has shown favorable response rates of OS and PFS in LACC patients ( 55 ). This therapeutic strategy is associated with a significant reduction in tumor size, which may improve prognosis by reducing the risk of recurrence and micrometastasis ( 56 ).…”

Recurrence risk stratification for locally advanced cervical cancer using multi-modality transformer network

“…Most LACC patients are routinely treated with concurrent chemoradiation therapy, and the prognosis is heterogeneous ( 3 ). Despite neoadjuvant and adjuvant therapies are being tentatively introduced into the treatment regimen, the overall outcomes are not significantly improved ( 4 , 5 ). The potential reason may be associated with the small-scale cohorts benefited from the neoadjuvant and adjuvant treatments, and all of these patients are from the high-risk recurrence group ( 6 ).…”