Weekly gemcitabine and cisplatin concurrent with pelvic irradiation for primary therapy of cervical cancer: report of the first seven cases in Thai women

Chumworathayi, Bandit; Yuenyao, Pissamai; Tangvorapongchai, Vorachai; Luanratanakorn, Sanguanchoke; Pattamadilok, Jeerichuda; Krusun, Srichai

doi:10.1007/s11604-007-0171-1

Cited by 4 publications

(1 citation statement)

References 18 publications

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“…However; previous study using weekly cisplatin 40mg/m 2 had reported ototoxicity in 10% 15 while nephrotoxicity occurred in 42.9% in a study using weekly combination of gemcitabine with this standard dose of cisplatin. 16 Among hematologic toxicity; anemia was the most common (35.5%) followed by thrombocytopenia (31%) then neutropenia (26.6%) with grade 3 in 4.4% and no grade 4 that comparable to finding by Umanzor et al 6 However; Zarba et al 5 recorded grade 4 neutropenia in 4%. Anemia was found in 50% of patients treated with gemcitabine 125mg/m 2 and cisplatin 40mg/m 2 .…”

Section: Discussionsupporting

confidence: 59%

Concurrent pelvic radiation with weekly low-dose cisplatin and gemcitabine as primary treatment of locally advanced cervical cancer: A phase II study

El-Hadaad

Wahba

Roshdy

et al. 2015

Int J Cancer Ther Oncol

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Original ArticleAbstract Purpose: This study was done to evaluate response, compliance and survival of weekly low dose cisplatin (20 mg/m 2 ) and gemcitabine (125 mg/m 2 ) concurrently with pelvic radiation as primary treatment of stage IIB-IIIB cervical cancer. Methods: External radiation consisted of 50 Gy/25 fractions using 6-10 MV photon followed by 600 cGy boost to parametrium if it was still felt thickened. Then, intracavitary radiotherapy to deliver 60 Gy at point A. Chemotherapy consisted of gemcitabine at a dose of 125 mg /m 2 was given by i.v infusion over 30 minutes immediately after cisplatin 20 mg /m 2 weekly for 5 weeks during EBRT. Fortyfive eligible patients received the treatment protocol. Results: Toxicity was tolerable and manageable. No grade 4 toxicity while grade 3 was recorded in hematologic one only. In order of frequency; diarrhea, nausea and vomiting, and anemia (50%, 40%, 35.5%) were most common adverse events. Overall clinical response rate was 93.4% with pathological complete response of 62.2%. After median follow-up of 20 months, 2-year survival and progression-free survival rates were 90.5% and 81% respectively. Conclusion: Weekly combination of low-dose cisplatin and gemcitabine given concurrently with pelvic radiotherapy in primary treatment of locally advanced cervical cancer resulted in a high response rate with a good compliance. Further exploration is needed for the use of this approach prior to incorporating it into routine clinical care through phase III clinical trial.

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Section: Discussionsupporting

confidence: 59%

Concurrent pelvic radiation with weekly low-dose cisplatin and gemcitabine as primary treatment of locally advanced cervical cancer: A phase II study

El-Hadaad

Wahba

Roshdy

et al. 2015

Int J Cancer Ther Oncol

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An integrative view of the pathophysiological events leading to cisplatin nephrotoxicity

Sánchez-González¹,

López‐Hernández²,

López‐Novoa³

et al. 2011

Critical Reviews in Toxicology

215

212

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Cisplatin is among the most effective chemotherapeutic agents against solid tumors. Nephrotoxicity is the most common side effect of cisplatin chemotherapy, which limits the clinical use of cisplatin and seriously worsens the quality of life of cancer patients resulting in dosage reduction and discontinuation of treatment. Cisplatin involves a complex multifactorial process, as it has direct toxic effect on cells of the renal tubules, vasculature and glomeruli, and causes alterations in renal blood flow and glomerular filtration rate. Indirectly, cisplatin also induces inflammation of the renal interstitium, which contributes to the acute damage and may lead to chronic interstitial fibrosis, indicative of irreversible renal damage. This review presents an integrative view of the pathophysiological effects of cisplatin on tubular, vascular, glomerular, and interstitial function and the interplay among these actions. Moreover, it reviewed human clinical trials of the last ten years in order to evaluate the incidence and severity of the renal injury induced by cisplatin at the doses and therapeutic guidelines used in the clinical practice.

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Weekly cisplatin or gemcitabine concomitant with radiation in the management of locally advanced carcinoma cervix: results from an observational study

et al. 2009

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Objective: The use of non-platinum drugs in concurrent chemoradiation in carcinoma cervix has not been well explored and hence a two arm study was planned to compare the outcome of concomitant cisplatin or gemcitabine in locally advanced carcinoma cervix. Methods: Thirty six patients were evaluated in this study for response rates and complications. These patients were divided into two arms, sixteen patients in the cisplatin arm and twenty patients in the gemcitabine arm. Cisplatin and gemcitabine were given as i.v. infusion at doses of 40 mg/m 2 and 150 mg/m 2 respectively for five weeks concomitant with radiotherapy. All patients had received pelvic radiotherapy to a dose of 50 Gy/25 fraction/5 weeks by four field box technique followed by high-dose-rate brachytherapy (3 sessions, each of 7.5 Gy to point A). Results: Median follow up was of 10.4 months (range, 3 to 36 months) and 10.9 months (range, 2 to 49 months) in the cisplatin and gemcitabine arms, respectively. At first follow up, 68.8% in the cisplatin arm and 70% in the gemcitabine arm had achieved complete response (p=0.93). Similar response rates were noted in different stages in both arms. None of the patients except one developed grade 4 toxicity. Similar toxicity profiles were observed in both arms. Local disease control, distant disease free survival and overall survival was 68.8% vs. 70%, 93.8% vs. 85%, 68.8% vs. 60% in the cisplatin and gemcitabine arms, respectively. Conclusion: Weekly gemcitabine had similar disease control and tolerable toxicity profile with cisplatin. Gemcitabine may be used as an alternative to cisplatin in patients with compromised renal function.

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Weekly gemcitabine and cisplatin concurrent with pelvic irradiation for primary therapy of cervical cancer: report of the first seven cases in Thai women

Cited by 4 publications

References 18 publications

Concurrent pelvic radiation with weekly low-dose cisplatin and gemcitabine as primary treatment of locally advanced cervical cancer: A phase II study

Concurrent pelvic radiation with weekly low-dose cisplatin and gemcitabine as primary treatment of locally advanced cervical cancer: A phase II study

An integrative view of the pathophysiological events leading to cisplatin nephrotoxicity

Weekly cisplatin or gemcitabine concomitant with radiation in the management of locally advanced carcinoma cervix: results from an observational study

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