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

Cancers

Margot Playe¹  Sabine Winterman²  Guilhem Bousquet²  Laurent Zelek²  Amélie Benbara³  Frédéric Pamoukdjian⁴  Van Tai Nguyen⁵ 

[1] Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Service de Médecine Nucléaire, 93000 Bobigny, France;Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Service d’Oncologie Médicale, 93000 Bobigny, France;Assistance Publique Hôpitaux de Paris, Hôpital Jean Verdier, Service de Gynécologie—Obstétrique, 93140 Bondy, France;Institut National de la Santé et de la Recherche Médicale (INSERM), UMR_S942, Université de Paris-Université Sorbonne Paris Nord, 93000 Bobigny, France;National Cancer Hospital, Department of Medical Oncology 1, Hanoi 10000, Vietnam;

关键词: locally advanced cervical cancer;    neoadjuvant therapy;    dose-intense cisplatin-based;   

DOI  :  10.3390/cancers14030842

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown