Assessment of intensified neoadjuvant chemotherapy regimens for locally advanced cervical cancer


DOI: https://dx.doi.org/10.18565/pharmateca.2019.12.37-43

O.A. Smirnova (1), N.E. Bondarev (1), E.A. Ulrikh (1, 2), N.A. Mikaya (1), Kh.B. Kotiv (1, 2), A.S. Petrova (1), A.O. Ivantsov (1), T.V. Gorodnova (1), E.A. Nekrasova (1), O.E. Lavrinovich (1), M.G. Yakovleva (1), A.V. Abramova (1), D.V. Malyutina (1), Sh.G. Parsyan (1), G.B. Mkrtchyan (1), Z.N. Ibragimov (1), Yu.N. Trifanov (1), A.A. Sidoruk (1), A.F. Urmancheeva (1, 2), I.V. Berlev (1, 2)

1) N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; 2) North-Western State Medical University n.a. I.I. Mechnikov, St. Petersburg, Russia
Background. Cervical cancer is the most common malignant tumor of the female reproductive system in the reproductive period. The age of patients at the initial detection of cervical cancer is becoming more and more young. The search for the optimal modality of neoadjuvant treatment of patients with locally advanced cervical cancer is a promising area of research. Systemic chemotherapy as a stage of neoadjuvant treatment of patients with locally advanced cervical cancer is currently considered as the therapy of choice, being a competitive alternative to chemoradiotherapy.
Objective. Evaluation of the results of using neoadjuvant dose-intensive platinum-containing chemotherapy in patients with FIGO IB2 – IIB locally advanced cervical cancer.
Methods. The efficacy and toxicity of three cycles of intravenous dose-intensive neoadjuvant chemotherapy according to the AP scheme (cisplatin 75 mg/m2, doxorubicin 35 mg/m2) and TP scheme (cisplatin 60 mg/m2 and paclitaxel at a dosage of 60 mg/m2) were studied in the patients participating in the study.
Results. The study included 105 primary patients (75 in the AP group and 30 in the TP group) at the age of 27–68 years (mean age, 44 years) with verified cervical cancer (cT1B2Nx, 0M0 – cT2BNx, 0M0). In the AP group, surgical treatment was performed in 88% (66 patients), in the TP group – in 80% (24 patients). Disease progression was detected in 8.0% (6 cases) in the AP group and in 3.3% (1 case) in the TP group. In 4 patients (2.8%) in the AP group, a relapse of the disease was diagnosed, and no relapses were recorded in the TP group. Dose-dense chemotherapy regimen did not lead to significant complications at the medicinal and surgical stages.
Conclusion. Analysis of the research results showed that dose-intensive neoadjuvant chemotherapy is an effective method with an objective response rate of 84% (63 cases) in the AP group and 56.7% in the TP group (17 cases). The pathological tumor response in the AP group was 89.4% (66 cases), and complete tumor regression (CTR) was confirmed in 10.6% (7 cases); in the TP group – 79.2% (24 cases), in 16,7% (4 cases) tumor regression was confirmed by a complete pathologic response. Dose-intensive neoadjuvant chemotherapy may be considered as an alternative to the standard treatment for locally advanced cervical cancer, but requires further research due to the small number of observations.
Keywords: locally advanced cervical cancer, dose-intensive neoadjuvant chemotherapy, cisplatin, pathological response, CTR

About the Autors


Corresponding author: Olga A. Smirnova, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; e-mail: ssmirnova.oa@gmail.com, ORCID: https://orcid.org/0000-0003-1140-6578 
Address: 68, Leningradskaya Street, Pesochny settlement, St. Petersburg 197758, Russian Federation


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