COMMENTARY

New RCT Favors Standard of Care for Locally Advanced Squamous Cervical Cancer

Maurie Markman, MD

Disclosures

July 30, 2018

Hello. I am Dr Maurie Markman from Cancer Treatment Centers of America in Philadelphia. I want to briefly discuss a very important paper that recently appeared in the Journal of Clinical Oncology, "Neoadjuvant Chemotherapy Followed by Radical Surgery Versus Concomitant Chemotherapy and Radiotherapy in Patients With Stage IB2, IIA, or IIB Squamous Cervical Cancer: A Randomized Controlled Trial."[1]

It has long been established that the use of concurrent chemoradiation therapy has been a major advance in the management of locally advanced cervical cancer. An important question concerns the potential utility of neoadjuvant chemotherapy followed by surgery and possibly further radiation therapy or even chemoradiation therapy in a similar patient population. Phase 2 data have looked at new adjuvant chemotherapy and have appeared promising, but we have seen no randomized controlled trial data [until now].

[This new study], from the excellent group at Tata Memorial Hospital in Mumbai, India, randomly assigned 635 patients to one of two treatment strategies: neoadjuvant chemotherapy followed by a radical hysterectomy and possible additional radiation therapy or the standard chemoradiation therapy. The 5-year disease-free survival in the neoadjuvant chemotherapy group was 69.3% versus 76.7% in the [standard radiotherapy plus concomitant cisplatin group], thus statistically significantly in favor of the control arm of standard chemoradiation therapy.

This is a very important observation. Clearly, the concept of neoadjuvant chemotherapy continues to be explored, but the standard of care for locally advanced squamous cell cervical cancers remains what has been established for quite a while now—cisplatin in combination with radiation therapy.

If you're interested in this area, I encourage you to read this very informative and extremely well-done paper. Thank you for your attention.

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