Chemotherapy For Cervical Cancer Research Articles

Chemotherapy for cervical cancer and contraception: discussion issues and clinical case

Cervical cancer occupies one of the leading places in the structure of oncological diseases of the Female Reproductive System. In the treatment of this pathology, along with the surgical method of treatment, chemotherapy and radiation therapy are used. According to clinical guidelines, in the presence of cervical cancer stages IIB–IIIA, it is allowed to carry out 2–4 cycles of neoadjuvant chemotherapy in order to create conditions for the possibility of performing extended hysterectomy according to Meigs. Pregnancy during chemotherapy is unique and extremely rare.The article presents a clinical case of pregnancy during chemotherapy (performed according to the scheme: taxanes and platinum-containing drugs) in a 27-year-old patient. According to the clinical picture and results of cervical biopsy, the diagnosis was made: invasive nonkeratinizing squamous cell carcinoma of the cervix IIB (cT2bNxM0) G2, right-sided parametric variant, nonspecific (with unspecified HPV status). Taking into account the presence of parametrial infiltration, the age of the patient, the oncological council prescribed from 2 to 4 cycles of chemotherapy according to the TC scheme (paclitaxel, carboplatin) with an interval assessment. After the second cycle of chemotherapy, an early pregnancy was diagnosed – a medical abortion was performed. Against the background of 3 cycles of chemotherapy, the conditions for surgical treatment were formed – surgical treatment was performed in the amount of extended hysterectomy according to Meigs (type III according to Piver/C2 Morrow) with transposition of the ovaries. The postoperative period was uneventful; the patient was discharged in a satisfactory condition.The described case of pregnancy on the background of chemotherapy is of scientific and practical interest, initiating a discussion on the need to counsel such patients regarding reliable contraception, taking into account the eligibility criteria, which will avoid undesirable outcomes during cancer treatment.

Risk Prediction Model for Radiation-induced Dermatitis in Patients with Cervical Carcinoma Undergoing Chemoradiotherapy

PurposeRadiation-induced dermatitis (RD) is a common side-effect of therapeutic ionizing radiation that can severely affect patient quality of life. This study aimed to develop a risk prediction model for the occurrence of RD in patients with cervical carcinoma undergoing chemoradiotherapy using electronic medical records (EMRs). MethodsUsing EMRs, the clinical data of patients who underwent simultaneous radiotherapy and chemotherapy at a tertiary cancer hospital between 2017 and 2022 were retrospectively collected, and the patients were divided into two groups: a training group and a validation group. A predictive model was constructed to predict the development of RD in patients who underwent concurrent radiotherapy and chemotherapy for cervical cancer. Finally, the model's efficacy was validated using a receiver operating characteristic curve. ResultsThe incidence of radiation dermatitis was 89.5% (560/626) in the entire cohort, 88.6% (388/438) in the training group, and 91.5% (172/188) in the experimental group. The nomogram was established based on the following factors: age, the days between the beginning and conclusion of radiotherapy, the serum albumin after chemoradiotherapy, the use of single or multiple drugs for concurrent chemotherapy, and the total dose of afterloading radiotherapy. Internal and external verification indicated that the model had good discriminatory ability. Overall, the model achieved an area under the receiver operating characteristic curve of .66. ConclusionsThe risk of RD in patients with cervical carcinoma undergoing chemoradiotherapy is high. A risk prediction model can be developed for RD in cervical carcinoma patients undergoing chemoradiotherapy, based on over 5 years of EMR data from a tertiary cancer hospital.

Polyphyllin I Sensitizes Cisplatin-Resistant Human Cervical Cancer Cells to Cisplatin Treatment

Cervical cancer (CC) is a common gynecological malignancy, and improving cisplatin sensitivity has become a hot topic in CC chemotherapy research. Polyphyllin I (PPI), a potent bioactive compound found in Rhizoma Paridis, known for its anticancer properties, remains underexplored in CC resistance. In this study, we evaluated PPI’s impact on cisplatin-resistant CC cells and elucidated its underlying mechanism. Our findings reveal that PPI enhances the sensitivity of cisplatin-resistant CC cells to the drug, promotes apoptosis, and inhibits cell migration. Mechanistically, PPI was found to regulate p53 expression and its target genes, and suppressing p53 expression reverses PPI’s sensitizing effect in drug-resistant CC cells. In conclusion, PPI showed promise in sensitizing cisplatin-resistant human CC cells to cisplatin treatment, suggesting that it could serve as a potent adjunct therapy for cervical cancer, particularly for cases that have developed resistance to cisplatin, thereby providing a promising basis for further clinical investigation into PPI for enhancing the efficacy of existing chemotherapy regimens in resistant cervical cancer.

Postoperative Hypofractionated Intensity-Modulated Radiotherapy With Concurrent Chemotherapy in Cervical Cancer

Prospective data assessing the safety of hypofractionated (40 Gy in 16 fractions) radiotherapy (RT) among patients who receive postoperative concurrent chemoradiotherapy for cervical cancer are lacking. To evaluate the acute toxic effects of hypofractionated pelvic intensity-modulated radiotherapy (IMRT) with concurrent chemotherapy among women with cervical cancer who underwent radical hysterectomy. The POHIM-CCRT (Postoperative Hypofractionated Intensity-Modulated Radiation Therapy With Concurrent Chemotherapy in Cervical Cancer) study was designed as a multicenter, phase 2 nonrandomized controlled trial that accrued and followed up patients from June 1, 2017, to February 28, 2023. In total, 84 patients were enrolled from 5 institutions affiliated with the Korean Radiation Oncology Group. Eligible patients experienced lymph node metastasis, parametrial invasion, or positive resection margins after radical hysterectomy for treatment of confirmed cervical cancer. Postoperative pelvic radiation using hypofractionated IMRT with 40 Gy in 16 fractions to the whole pelvis combined with concurrent chemotherapy. The primary end point was incidence of acute grade 3 or higher gastrointestinal tract, genitourinary, and hematologic toxic effects (based on the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0) in the evaluable population during RT or within 3 months after RT completion. Of 84 patients enrolled, 5 dropped out prior to RT, and data from 79 patients were analyzed. The patients' median (IQR) age was 48 (42-58) years, and the median (IQR) tumor size was 3.7 (2.7-4.5) cm. Of these patients, 31 (39.7%) had lymph node metastasis, 4 (5.1%) had positive resection margins, and 43 (54.4%) had parametrial invasion. Grade 3 or higher acute toxic effects occurred in 2 patients (2.5% [90% CI, 0%-4.8%]). After a median (IQR) follow-up of 43.0 (21.1-59.0) months, the 3-year disease-free survival rate was 79.3%, and the overall survival rate was 98.0%. Findings from this nonrandomized control trial indicated that postoperative pelvic irradiation combined with concurrent chemotherapy using hypofractionated IMRT with 40 Gy in 16 fractions was safe and well-tolerated in women with cervical cancer. Studies assessing long-term toxic effects and oncological outcomes with longer follow-up periods are needed. ClinicalTrials.gov Identifier: NCT03239613.

MTH1 inhibition synergizes with ROS-inducing agents to trigger cervical cancer cells undergoing parthanatos

Cervical cancer cells possess high levels of reactive oxygen species (ROS); thus, increasing oxidative stress above the toxicity threshold to induce cell death is a promising chemotherapeutic strategy. However, the underlying mechanisms of cell death are elusive, and efficacy and toxicity issues remain. Within DNA, 8-oxo-7,8-dihydroguanine (8-oxoG) is the most frequent base lesion repaired by 8-oxoguanine glycosylase 1 (OGG1)-initiated base excision repair. Cancer cells also express high levels of MutT homolog 1 (MTH1), which prevents DNA replication-induced incorporation of 8-oxoG into the genome by hydrolyzing 8-oxo-7,8-dihydro-2′-deoxyguanosine 5′-triphosphate (8-oxo-dGTP). Here, we revealed that ROS-inducing agents triggered cervical cancer to undergo parthanatos, which was mainly induced by massive DNA strand breaks resulting from overwhelming 8-oxoG excision by OGG1. Furthermore, the MTH1 inhibitor synergized with a relatively low dose of ROS-inducing agents by enhancing 8-oxoG loading in the DNA. In vivo, this drug combination suppressed the growth of tumor xenografts, and this inhibitory effect was significantly decreased in the absence of OGG1. Hence, the present study highlights the roles of base repair enzymes in cell death induction and suggests that the combination of lower doses of ROS-inducing agents with MTH1 inhibitors may be a more selective and safer strategy for cervical cancer chemotherapy.

IJCM_162A: Evidence on the Influence of Economic Variables on Breast and Cervical Cancer Treatment in South Asia: Implications for Healthcare Strengthening - A Scoping Review

Background: Cancer, a leading cause of death globally, imposes a substantial economic burden to the family and family members. This study focuses on the financial aspects of breast and cervical cancer treatments in South Asia, aiming to identify both the direct and indirect costs patients face and the financial barriers and enablers to accessing care. Utilizing the Arksey and O’Malley framework, a scoping review of literature from 2006 onward was conducted, examining costs associated with treatment modalities like radiotherapy, chemotherapy, and surgery for breast and cervical cancer. Results: Analysis of 192 records led to 12 studies being reviewed in detail. Results showed that treatment costs for cervical cancer ranged from INR 19,494 to 41,388 (USD 291 – 617), with about 62% of patients incurring catastrophic health expenditures. Breast cancer treatment also proved costly, with expenses ranging widely but averaging around Rs. 48,477. Such high out-of-pocket costs not only pose a significant financial challenge for patients but also threaten the effectiveness of international health initiatives aimed at cancer treatment and management. Conclusion: The study concludes that the financial burden of breast and cervical cancer treatments in South Asia is significant, highlighting the urgent need for healthcare systems to mitigate these costs. Enhancing support for both medical and non-medical expenses is essential for reducing financial strain on patients, ensuring equitable access to treatments, and advancing towards the goals of global healthcare initiatives.

PBRM1 presents a potential ctDNA marker to monitor response to neoadjuvant chemotherapy in cervical cancer

Neoadjuvant chemotherapy (NACT) is a therapeutic option for locally advanced cervical cancer (LACC) patients. This study was aimed to identify potential liquid biopsy biomarkers to monitor the NACT response. Through targeted next-generation sequencing (NGS) analysis of circulating tumor DNA (ctDNA) and tumor tissue DNA (ttDNA) taken from LACC patients undergoing platinum-based NACT, 64 genes with mutations emerge during NACT in the non-responders but none in the responders. Among them, the PBRM1, SETD2, and ROS1 mutations were frequently detected in the ctDNA and ttDNA of the non-responders, and mutant PBRM1 was associated with poorer survival of patients. Invitro, PBRM1 knockdown promoted resistance to cisplatin through boosting STAT3 signaling in cervical cancer cells, while it sensitized tumor cells to poly-ADP-ribose-polymerase inhibitor olaparib. These findings suggest that mutant PBRM1 is a potential ctDNA marker of emerging resistance to NACT and of increased sensitivity to olaparib, which warrants further clinical validation.

POTENTIAL KETAPANG (Terminalia cattapa) LEAF EXTRACT AS A DOXORUBICIN CO-CHEMOTHERAPY AGENT ON BREAST (T47D) AND CERVIX (HeLa) CANCER CELL LINES

Doxorubicin (DOX) is chemotherapy for breast and cervical cancer with serious side effects. Ketapang (Terminalia cattapa) is a potential plant as a co-chemotherapy agent. The purpose of this research was to examine the sensitivity of DOX as a cytotoxicity drug in combination with ethanolic extracts of ketapang leaves (EKL) against T47D and HeLa cancer cells. Cytotoxicity was determined using the MTT assay, with DOX concentration series (0.625-40 nM for T47D and 0.5-6 M for HeLa) and EKL (50-1000 mg/mL) used in combination with the study. DOX and EKL combination assays utilizing their respective IC50 values were performed in T47D cells and HeLa cells, and the results were used to calculate the Combination Index (CI). Furthermore, the doubling time method was used to investigate the combination of DOX and EKL proliferation inhibition on both cell lines. DOX and EKL had IC50 values of 158 nM and 30 mg/mL for T47D, respectively, and 3.4 M and 640 mg/mL for HeLa cell growth. While DOX and EKL have a synergistic effect on T47D cells, their combined effect on HeLa cells is cytotoxic and dose-dependent. EKL increases the inhibitory effect of DOX on the proliferation of T47D and HeLa cancer cells. In T47D cells, the combination of DOX and EKL has a higher potential for cytotoxic and antiproliferative activity than in HeLa cells

Applicability of perfusion weighted imaging in evaluating the curative effect of endostar combined with neoadjuvant chemotherapy in advanced cervical cancer

Purpose: To investigate the applicability of perfusion-weighted imaging (PWI) in evaluating the curative effect of endostar (EN) combined with neoadjuvant chemotherapy (NAC) in advanced cervical cancer.
 Methods: Between January 2021 and December 2022, 85 patients from Gansu Provincial Maternity and Child-care Hospital, China with advanced cervical cancer received NAC intravenously and underwent pre and post-chemotherapy PWI. Neoadjuvant chemotherapy (NAC) consisted of paclitaxel (135 - 175 mg/m2) and carboplatin (300 - 400 mg/m2). The NAC regimen comprised three courses, with each course lasting three weeks. General data, gross tumor volume (GTV), maximum signal intensity loss rate (MSILR), tumor regression rate (TRR), and post-chemotherapy MSILR reduction were compared between effective and non-effective groups.
 Results: There was a significant difference in International Federation of Gynecology and Obstetrics (FIGO) staging, pathological types and proportion of lymph node metastasis between effective and non-effective groups (p < 0.05). At the end of 3 cycles of chemotherapy, ORR was 72.94 %. After treatment with EN combined with NAC, GTV and MSILR in effective group were significantly lower compared to non-effective group (p < 0.05). After chemotherapy, the mean relative ratio (MRR) and MSILR in effective group were significantly higher compared to non-effective group (p < 0.05). Also, MSILR before treatment (EN combined with NAC) was positively correlated with TRR after chemotherapy in patients with advanced cervical cancer (p < 0.05).
 Conclusion: Perfusion-weighted imaging effectively changes tumor volume in patients with advanced cervical cancer after treatment with EN combined with NAC, and this has high application in evaluating the drug’s curative effect.

Atezolizumab plus bevacizumab and chemotherapy for metastatic, persistent, or recurrent cervical cancer (BEATcc): a randomised, open-label, phase 3 trial

The GOG240 trial established bevacizumab with chemotherapy as standard first-line therapy for metastatic or recurrent cervical cancer. In the BEATcc trial (ENGOT-Cx10-GEICO 68-C-JGOG1084-GOG-3030), we aimed to evaluate the addition of an immune checkpoint inhibitor to this standard backbone. In this investigator-initiated, randomised, open-label, phase 3 trial, patients from 92 sites in Europe, Japan, and the USA with metastatic (stage IVB), persistent, or recurrent cervical cancer that was measurable, previously untreated, and not amenable to curative surgery or radiation were randomly assigned 1:1 to receive standard therapy (cisplatin 50 mg/m2 or carboplatin area under the curve of 5, paclitaxel 175 mg/m2, and bevacizumab 15 mg/kg, all on day 1 of every 3-week cycle) with or without atezolizumab 1200 mg. Treatment was continued until disease progression, unacceptable toxicity, patient withdrawal, or death. Stratification factors were previous concomitant chemoradiation (yes vs no), histology (squamous cell carcinoma vs adenocarcinoma including adenosquamous carcinoma), and platinum backbone (cisplatin vs carboplatin). Dual primary endpoints were investigator-assessed progression-free survival according to Response Evaluation Criteria in Solid Tumours version 1.1 and overall survival analysed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT03556839, and is ongoing. Between Oct 8, 2018, and Aug 20, 2021, 410 of 519 patients assessed for eligibility were enrolled. Median progression-free survival was 13·7 months (95% CI 12·3-16·6) with atezolizumab and 10·4 months (9·7-11·7) with standard therapy (hazard ratio [HR]=0·62 [95% CI 0·49-0·78]; p<0·0001); at the interim overall survival analysis, median overall survival was 32·1 months (95% CI 25·3-36·8) versus 22·8 months (20·3-28·0), respectively (HR 0·68 [95% CI 0·52-0·88]; p=0·0046). Grade 3 or worse adverse events occurred in 79% of patients in the experimental group and in 75% of patients in the standard group. Grade 1-2 diarrhoea, arthralgia, pyrexia, and rash were increased with atezolizumab. Adding atezolizumab to a standard bevacizumab plus platinum regimen for metastatic, persistent, or recurrent cervical cancer significantly improves progression-free and overall survival and should be considered as a new first-line therapy option. F Hoffmann-La Roche.

297P The utilization rate of radiotherapy and chemotherapy for cervical cancer in Indonesia: Optimal versus actual, how far the gap?

297P The utilization rate of radiotherapy and chemotherapy for cervical cancer in Indonesia: Optimal versus actual, how far the gap?

Correlation of Post-Treatment Biopsy and Fluorodeoxyglucose PET/CT Findings Following Definitive Chemotherapy and Radiation for Cervical Cancer

Concurrent chemotherapy and external beam radiation with brachytherapy boost is considered standard of care for treatment of locally advanced cervical cancer. Post treatment surveillance fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging is recommended 3-6 months after completion of therapy. Persistent FDG avidity is commonly observed at the cervix on surveillance scans, indeterminate for residual malignancy versus post treatment inflammatory change. To better understand the clinical significance of residual hypermetabolic activity, we performed an analysis of surveillance FDG-PET/CT images, correlating findings with post treatment cervical biopsy results after completion of therapy. The medical records of all patients treated with definitive chemotherapy and radiation for locally advanced (FIGO IB3 to IVA) cervical cancer at a single academic medical center between 2017 and 2022 were reviewed. Patients were treated with curative intent using a combination of pelvic external beam radiation with concurrent cisplatin chemotherapy followed by intracavitary or combined intracavitary/interstitial brachytherapy boost. Patients underwent FDG-PET/CT imaging at 3-6 months upon completion of therapy, followed by biopsy either for suspected residual disease or equivocal findings on physical exam or FDG-PET/CT scans. Biopsies were obtained within 100 days of FDG-PET/CT imaging (median, 14 days). Twenty-three patients met inclusion criteria. One patient was excluded from analysis due to lack of FDG avidity on her pre-treatment FDG-PET/CT. Among the 22 evaluable scans, median pre-treatment FDG- PET/CT SUVmax of the cervix was 16.3 (range, 4.9-55). Median post-treatment SUVmax was 4.4 (range, 2.1-7.4). Median change in SUVmax from pre-treatment to post-treatment was 11.8 (range, 1.1 to 50.6). Twenty patients had a post-treatment SUVmax of greater than 3. Among post treatment scans, eight showed no residual uptake; two showed uptakes equal to the liver; eleven showed uptakes moderately higher than liver; and one showed uptake markedly increased relative to liver. None of the biopsy specimens showed evidence of residual malignancy, instead showing fibroinflammatory necrosis and reactive changes. None of the patients developed clinical evidence of disease progression at the cervix within one year of treatment completion. Residual hypermetabolic activity at the cervix is common following definitive chemotherapy and radiation for cervical cancer. This is unlikely to represent residual viable malignancy. Post treatment FDG-PET/CT imaging remains valuable for detecting locoregional or distant disease progression/persistence following therapy.

Galectin-7 promotes cisplatin efficacy by facilitating apoptosis and G3BP1 degradation in cervical cancer

The emergence of chemoresistance in cervical cancer is extremely challenging in chemotherapy. Oxidative stress has emerged as the regulatory factor in drug resistance, but the detailed mechanism is still unknown. Stress granules, are membrane-less ribonucleoprotein-based condensates, could enhance chemoresistance by sequestering proapoptotic proteins inhibition of cell death upon exposure to drug-induced oxidative stress. Galectin-7, a member of galectin family, exerts varied roles in tumor repression or progression in different cancers. However, its role in cervical cancer has not been sufficiently studied. Here, we found that galectin-7 promotes cisplatin (CDDP) induced apoptosis and associates with stress granule-nucleating protein G3BP1 degradation. With the treatment of cisplatin, galectin-7 could enhance apoptosis by upregulating cleaved-PARP1 and the generation of reactive oxygen species (ROS), promoting mitochondrial fission, and reducing mitochondrial membrane potential (MMP). Furthermore, galectin-7 also reduces resistance by facilitating cisplatin-induced stress granules clearance through galectin-7/RACK1/G3BP1 axis. All these data suggested that galectin-7 promotes cisplatin sensitivity, and it would be potential target for potentiating efficacy in cervical cancer chemotherapy.

Prophylactic Para-Aortic Extended Field Irradiation with Concurrent Chemotherapy for FIGO Stage IIIC1 Cervical Cancer Using Intensity Modulated Radiotherapy Technique: Acute Toxicity and Dosimetric Assessment

To evaluate the efficacy of P - PART with concurrent chemotherapy in LACC with the use of intensity modulated radiotherapy technique (IMRT). Our Primary endpoint was to assess acute toxicities and secondary endpoint was to assess loco-regional control (LRC), disease free-survival (DFS), para-aortic recurrence free survival (PA-RFS). A total of 30 patients of squamous cell carcinoma of cervix with stage IIIC1 (FIGO-2018) were recruited in this prospective, single arm interventional phase II study between January 2021 to September 2022. 18FDG-PET CT was performed and those with positive PALN were excluded. IMRT was used to deliver a dose of 50 Gy in 25 fractions to whole pelvis and PALN chain below renal hilum till aortic bifurcation received 45 Gy in 25 fractions. Concurrent cisplatin was administered weekly at 40 mg/m2 during radiation. On completion of external beam radiotherapy, high dose rate intracavitary brachytherapy was given at 7 Gy per fraction in 3 fractions prescribed to HR-CTV. Acute toxicities were assessed using CTCAE version 5.0. Median age was 50 years (37-66 years). All patients had completed treatment as per protocol. All patients had positive pelvic nodes with the maximum nodal short axis dimension of 14 mm (10-18 mm). All patients had positive internal iliac group of LNs, only 2(6.6%) patients had positive common iliac group of Ln. Median number of concurrent cisplatin cycles given were 5 (3-5 cycle). Median overall treatment time was 56 days (52-63 days) and median follow up was 15 months (3-22 month). Median cumulative dose to HR-CTV was 84.3Gy (Range:79.2-86.9Gy). Cumulative median EQD2 to 2cc of bladder and rectum were 69.11Gy (Range:59.17 - 80.07 Gy) and 64.6 Gy (Range: 60.1-66.3Gy) respectively. 7(23.3%) patients having grade 3 diarrhea and 2(6.67%) patients had grade 3 anemia while no significant genitourinary or other toxicities were noted. Patient characteristics, dosimetric data are described in Table-1. All patients underwent clinical and radiological assessment at the time of last follow up with one (3.33%) patient experiencing local failure at 9 months of follow up, hence crude LRC rate is 96.6%, DFS is 13.5 months (5-22 months) and PA-RFS is 16 months (8-23 months) till last date of follow up. Prophylactic EFRT with concurrent chemotherapy using IMRT technique yielded excellent short term clinical outcomes with acceptable toxicity profiles. Longer follow up will elucidate late toxicity and long-term clinical outcomes.

Maintenance Therapy for Recurrent or Metastatic Cervical Cancer: A Multicenter, Cohort Study

Maintenance therapy with alternative agents after chemotherapy was shown to improve the overall survival in some advanced cancers such as breast cancer, lung cancer, ovarian cancer and so on. However, maintenance therapy is not accepted as the standard treatment for recurrent/metastatic cervical cancer. Aim of this study is to elucidate the efficacy of maintenance therapy in cervical cancer and to explore the factors associated with the prognosis of recurrent or metastatic cervical cancer. In this multicenter cohort study, we retrospectively collected patients with a diagnosis of either recurrent or stage IVB cervical cancer to receive first-line chemotherapy with or without maintenance therapy. Patients did not have disease progression with first-line chemotherapy and were divided into maintenance therapy group (Arm A) and conventional chemotherapy group (Arm B). Information on clinical characteristics, metastasis information, treatment outcome and survival of patients was collected using an electronic medical record system. The endpoints of the study were OS and PFS. Data were analyzed for general characteristics and survival using statistical software, and the results were considered statistically significant at P < 0.05. Between January 2019 and July 2021, a total of 270 patients were enrolled from 6 institutions in China. 26 patients were excluded because of short treatment cycles (less than 3 cycles). Finally, a total of 66 patients in Arm A and 178 patients in Arm B were analyzed for survival. The addition of maintenance significantly prolonged overall survival. Overall survival at 3 year was 50.1% in Arm A and 27.8% in Arm B (median overall survival, ≥36 months vs. 22 months; P<0. 001). The median progression-free survival was 21 months in Arm A and 14 months in Arm B (P = 0.025). Univariate survival analysis showed that age, maintenance therapy, combined radiotherapy, and number of extra-pelvic metastases were associated with PFS. Further multifactorial analysis showed that maintenance therapy, combined radiotherapy, and number of extra-pelvic metastases were independent prognostic factors for patients with recurrent or metastatic cervical cancer. The addition of maintenance therapy significantly prolonged overall survival as well as progression-free survival in patients with recurrent or metastatic cervical cancer and did not increase the incidence of serious adverse events. It is time to consider maintenance therapy as the standard treatment after conventional chemotherapy for recurrent or metastatic cervical cancer, rather than waiting for disease progression.

Successful neoadjuvant chemotherapy plus sintilimab for locally advanced cervical cancer: case series and review of the literature

BackgroundThe locally advanced cervical cancer (LACC) of FIGO stage IB3-IIA2 is characterized by large local mass, poor prognosis and survival rate. Tumor response to neoadjuvant chemotherapy for LACC, utilized as a surrogate endpoint, is urgently needed to improve. Given that the antitumor immune response can be suppressed by programed death-1 axis, the treatment paradigm of neoadjuvant chemotherapy combined with immunotherapy has been explored as one of the prognostic treatments in a variety of solid carcinoma. So far, the application of sintilimab, a domestic immune checkpoint inhibitor, combined with neoadjuvant chemotherapy is still limited in LACC, especially in large lesions.Case descriptionWe present three postmenopausal women diagnosed with FIGO stage IB3-IIA2 cervical squamous cell carcinoma with lesions larger than 5 cm. Demographic, clinical, histopathological, laboratory and imaging data were record. At the completion of the neoadjuvant therapy with paclitaxel plus carboplatin combined with sintilimab, all patients underwent hysterectomy. After neoadjuvant treatment, a pathologic complete response in case 1 and partial responses in case 2 and case 3 were achieved, and neither patient showed any relapse during the follow-up period of 16 to 22 months.ConclusionsThis report provide evidence to support the combination of sintilimab with neoadjuvant chemotherapy in cervical cancer, which has yet to be validated in prospective studies. More clinical data are needed to verify the effectiveness of the combined regimens. This literature review also collected studies involving potential predictors of response to NACT and immunotherapy, which would be helpful in stratifying patients for future trials.

Adherence rate and barriers to completion of chemotherapy in recurrent or metastatic cervical cancer in an underserved Hispanic patient population (2246)

Adherence rate and barriers to completion of chemotherapy in recurrent or metastatic cervical cancer in an underserved Hispanic patient population (2246)

Toripalimab combined with bevacizumab and chemotherapy for refractory, recurrent or metastatic cervical cancer: preliminary results of a single-arm, open-label, phase II trial (LBA 3)

Toripalimab combined with bevacizumab and chemotherapy for refractory, recurrent or metastatic cervical cancer: preliminary results of a single-arm, open-label, phase II trial (LBA 3)

Metachronous Ovarian Cancer after a Radical Hysterectomy with Ovarian Conservation for Early-Stage Cervical Cancer: A Case Report

Introduction: Cervical cancer is the fourth most common disease in women worldwide and the leading cause in Tanzania, with 9,772 new cases and 6,695 deaths annually. Surgery is better than radiation or chemotherapy for early-stage cervical cancer (stages IA2–IIA1). Due to the risks of oophorectomy in young women, ovarian conservation is crucial. Metachronous ovarian cancer is understudied, however, ovarian conservation does not enhance cervical cancer mortality. Clinical presentation: We report a rare case of recurrent metachronous ovarian cancer in a 42-year-old female, Para 3, Living 3, who had her ovaries conserved following a radical hysterectomy and bilateral lymph node dissection for stage IB2 cervical cancer at 37 years old in April 2017. The final biopsy showed a well-differentiated, invasive cervical adenocarcinoma. Stage IV ovarian cancer with significant ascites and pleural effusion was detected in July 2018, 14 months post-surgery. Six chemotherapy treatments and total tumor debulking succeeded. Despite the most effective cytoreduction surgery, the patient experienced two further recurrences in 2020 and 2022. After additional surgeries and chemotherapy, she is currently in complete remission and will be followed up. Conclusion: Young women undergoing radical hysterectomy for early-stage cervical cancer must preserve their ovaries, but metachronous ovarian cancer is a risk. Thus, metachronous ovarian cancer risks, challenges, and outcomes must be understood.

Retracted: Construction of Nursing Practice Model in Case Management of Concurrent Chemotherapy and Radiochemotherapy Treatment in Cervical Cancer.

[This retracts the article DOI: 10.1155/2022/5450575.].