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Impact of Induction Chemotherapy on Cervical Cancer Survival and Relapse Rates

Advancements in cancer survival rates owe much to the advancements in enhanced treatments, preventive measures, along with effective screening initiatives. Specifically focusing on cervical cancer, efforts have concentrated on early detection methods through screening and widespread adoption of human papillomavirus (HPV) vaccination to prevent its onset. Despite these measures, some individuals still face diagnoses of advanced cervical cancer, facing the need for robust treatment approaches.(1,2)

A recent groundbreaking study has showcased promising strides in improving overall survival rates for advanced cervical cancer. The research, presented at the European Society for Medical Oncology (ESMO) congress on October 22, 2023, unveiled the potential efficacy of induction therapy – a form of initial chemotherapy treatment.(3)

This clinical trial, known as INTERLACE phase III, commenced in 2012 with an aim to assess the effectiveness of induction therapy in individuals battling advanced cervical cancer. The trial’s outcomes, revealed in the abstract published in the famous Annals of Oncology, demonstrated a remarkable advancement. Induction therapy exhibited a staggering 39 percent improvement in overall survival rates among those grappling with advanced cervical cancer.(4)

The study, funded by Cancer Research UK and UCL Cancer Trials Centre, marked a significant breakthrough in the realm of cervical cancer treatment.(5) It underscored the potential of induction therapy as a pivotal first-line treatment, heralding newfound hope for many individuals who are facing the challenges of advanced-stage cervical cancer. 

These findings not only offer promise, but also pave the way forward for many more innovative treatment strategies that could potentially redefine the landscape of managing advanced cervical cancer.

What Exactly is Induction Chemotherapy?

Induction chemotherapy marks a significant stride in cancer treatment. It refers to the initial treatment administered for a disease before other therapies commence, as defined by the National Cancer Institute. This approach has played a pivotal role in managing aggressive cancers deemed at high risk of spreading.(6)

Notably, induction chemotherapies have showcased effectiveness in bolstering overall survival rates across various aggressive cancers such as breast cancer, lung cancer, acute myeloid leukemia and pancreatic cancer.(7,8) These treatments often serve as a precursor to additional chemotherapy, surgery, or radiotherapy, presenting a strategic approach in combating cancer’s aggressive nature.

The decline in cancer mortality rates in recent years, acknowledged by reports from the American Cancer Society in the United States and the National Health System in the United Kingdom, underscores the important contributions of advancements in early detection and treatment modalities.(9,10) The introduction and efficacy of induction chemotherapies represent a major milestone in the ever-changing landscape of cancer care, offering new hope in the fight against cancer.

Using Induction Chemotherapy for Cervical Cancer: What the Study Found

Researchers conducted a study encompassing 500 women diagnosed with cervical cancer across various stages and centers in the U.K., Mexico, India, Italy, and Brazil. This cohort was divided into two arms to investigate the impact of different treatment approaches.(11)

One group received six weekly doses of carboplatin and paclitaxel chemotherapy, followed by cisplatin and radiation therapy for up to six weeks.(12) The second group underwent the standard regimen of six weeks of chemotherapy and radiation therapy for their cancer.

According to the lead researcher of the study, the main focus of their research was on reducing the risks of cancer recurrence. The objective was to assess if additional chemotherapy prior to standard treatment could minimize the chances of cancer recurrence in vital areas like the lungs, liver, and abdominal lymph glands.

Following a five-year follow-up, patients receiving induction chemotherapy showed significantly higher overall survival rates. The cohort treated with induction therapy, chemotherapy, and radiotherapy showcased an impressive 80 percent five-year overall survival rate, as compared to the 72 percent rate observed amongst those undergoing standard chemotherapy and radiotherapy alone. This marked a remarkable 39 percent decrease in the risk of death over the five years in patients receiving induction therapy.

In terms of the study, it is important to understand what exactly is progression-free survival. Progression-free survival refers to the duration during which patients remain free from cancer progression or spreading. The group treated with induction therapy, chemotherapy, and radiotherapy showed a 73 percent five-year progression-free survival rate, while the standard treatment group showed a 64 percent rate. This revealed a whopping 35 percent reduction in the risk of progression following treatment among those receiving induction therapy.(13)

However, while induction chemotherapy did show enhanced clinical outcomes, patients in this group also ended up experiencing more significant side effects that impacted their daily lives. Nearly 59 percent of the induction therapy group faced interfering side effects, as compared to the 48 percent in the standard treatment group. This indicates that balancing treatment benefits with manageable side effects still remains an important consideration in cervical cancer management strategies.

Researchers Advocate for Using Induction Therapy

After carrying out a comprehensive study, the researchers concluded that the results strongly supported recommending induction therapy as part of standard care for cervical cancer patients. They emphasized its potential inclusion in the regular treatment protocol for this specific patient demographic.

Highlighting the trial’s successful implementation across five different countries, the researchers showcased the adaptability of this treatment within various healthcare systems. The research team further expressed their intention to push for changes in the guidelines concerning cervical cancer treatment based on these findings.

Additionally, the team aims to empower women to discuss this option with their healthcare providers as the treatment is both cost-effective and easily accessible, making it a strong candidate for quick integration into clinical guidelines.

Insights on Cervical Cancer: Impact of the Findings and Prevention Strategies

According to oncologists not involved with the study, the study’s outcomes definitely hold clinical significance. Many claimed that the findings from this study holds the potential to reshape the overall approach to cancer treatment, especially in the management of locally advanced tumors.

However, experts also stressed that there was a need for more comprehensive data publication from the trial before clinicians could rely on these outcomes for decision-making.

Regarding the prevention of cervical cancer, oncologists further underscored the importance of the introduction of the HPV vaccine initially to adolescent girls in 2006 and later to boys before sexual activity commencement. This was primarily aimed at curbing infections and subsequent cervical cancer development.(14)

According to research, cervical cancer rates in the US amongst individuals in their 20s notably fell by 65 percent between 2012 and 2019.(15) Researchers attributed this decline to the HPV vaccine’s introduction in 2006, hinting at a further potential reduction in cervical cancer rates.

It is important for people to understand that cervical cancer prevention primarily revolves around reducing the risk of Human Papillomavirus (HPV) infection, as HPV is a leading cause of cervical cancer. Here are some other tips on how to prevent cervical cancer: 

  1. HPV Vaccination: The HPV vaccine is highly effective in preventing cervical cancer. It is recommended for adolescents (both boys and girls) around the age of 11 or 12. The vaccine can also be administered up to age 26 for individuals who have not been previously vaccinated.(16,17)
  2. Regular Screening: Routine cervical cancer screening through Pap tests (Pap smears) or HPV tests can detect any abnormal changes in the cervix before cancer develops. Guidelines for screening frequency may vary based on age and risk factors. Consult a healthcare professional to determine the appropriate screening schedule. (18)
  3. Safe Sex Practices: Practicing safe sex by using condoms can reduce the risk of HPV and other sexually transmitted infections (STIs). However, HPV can still be transmitted through skin-to-skin contact in areas not covered by a condom.
  4. Avoiding Smoking: Smoking can increase the risk of cervical cancer. Quitting smoking or avoiding exposure to secondhand smoke can help lower this risk.
  5. Maintaining a Healthy Lifestyle: A well-balanced diet, regular exercise, and maintaining a healthy weight can contribute to overall well-being, potentially reducing the risk of cervical cancer.
  6. HPV Awareness and Education: Educating oneself and others about HPV, its risks, and preventive measures can encourage timely vaccination and screening, aiding in early detection and prevention.

It is important to note that while these measures significantly reduce the risk of cervical cancer, they do not guarantee complete prevention. Regular screenings and vaccinations are crucial for early detection and prevention. Consulting with a healthcare provider is also recommended to understand personalized risk factors and to determine the most suitable preventive measures.

Conclusion

The impact of induction chemotherapy on cervical cancer survival and relapse rates shows promising results based on current studies. Several research findings suggest that incorporating induction chemotherapy into the treatment regimen for cervical cancer, particularly in locally advanced cases, may contribute to improved survival outcomes and reduced relapse rates.

While the results are encouraging, more extensive and longer-term studies are needed to establish the definitive impact of induction chemotherapy on cervical cancer survival and relapse rates. Additionally, understanding its efficacy in different stages of the disease, its potential side effects, and the best combinations with other treatments is crucial for comprehensive and personalized care.

While early findings are promising, further research and clinical evidence are necessary to ascertain the precise role and long-term benefits of induction chemotherapy in improving survival rates and reducing relapses for individuals diagnosed with cervical cancer.

References:

  1. Schiffman, M., Castle, P.E., Jeronimo, J., Rodriguez, A.C. and Wacholder, S., 2007. Human papillomavirus and cervical cancer. The lancet, 370(9590), pp.890-907.
  2. Burd, E.M., 2003. Human papillomavirus and cervical cancer. Clinical microbiology reviews, 16(1), pp.1-17.
  3. www.esmo.org. (n.d.). ESMO Congress 2023. [online] Available at: https://www.esmo.org/meeting-calendar/past-meetings/esmo-congress-2023 [Accessed 20 Nov. 2023].
  4. McCormack, M., Rincón, D.G., Eminowicz, G., Diez, P., Farrelly, L., Kent, C., Hudson, E., Panades, M., Mathews, T., Anand, A. and Persic, M., 2023. LBA8 A randomised phase III trial of induction chemotherapy followed by chemoradiation compared with chemoradiation alone in locally advanced cervical cancer: The GCIG INTERLACE trial. Annals of Oncology, 34, p.S1276.
  5. Ucl.ac.uk. (2023). Available at: https://www.ctc.ucl.ac.uk/ [Accessed 20 Nov. 2023].
  6. Aigner, K.R. and Stephens, F.O., 2011. Induction chemotherapy. Springer.
  7. Feldman, L.D., Hortobagyi, G.N., Buzdar, A.U., Ames, F.C. and Blumenschein, G.R., 1986. Pathological assessment of response to induction chemotherapy in breast cancer. Cancer Research, 46(5), pp.2578-2581.
  8. Vokes, E.E., 2010. Induction chemotherapy for head and neck cancer: recent data. The oncologist, 15(S3), pp.3-7.
  9. GOV.UK. (n.d.). Cancer survival rates improve by almost 10%. [online] Available at: https://www.gov.uk/government/news/cancer-survival-rates-improve-by-almost-10.
  10. www.cancer.gov. (2011). NCI Search Results – NCI. [online] Available at: https://www.cancer.gov/search/results?swKeyword=induction+therapy [Accessed 20 Nov. 2023].
  11. www.cancerresearchuk.org. (n.d.). Stages, types and grades | Cervical cancer | Cancer Research UK. [online] Available at: https://www.cancerresearchuk.org/about-cancer/cervical-cancer/stages-types-grades.
  12. Du Bois, A., Neijt, J.P. and Thigpen, J.T., 1999. First line chemotherapy with carboplatin plus paclitaxel in advanced ovarian cancer-a new standard of care?. Annals of oncology, 10, pp.S35-S41.
  13. Broglio, K.R. and Berry, D.A., 2009. Detecting an overall survival benefit that is derived from progression-free survival. JNCI: Journal of the National Cancer Institute, 101(23), pp.1642-1649.
  14. Markowitz, L.E., Gee, J., Chesson, H. and Stokley, S., 2018. Ten years of human papillomavirus vaccination in the United States. Academic pediatrics, 18(2), pp.S3-S10.
  15. Siegel, R.L., Miller, K.D., Wagle, N.S. and Jemal, A. (2023). Cancer statistics, 2023. CA: A Cancer Journal for Clinicians, 73(1), pp.17–48.
  16. Lee, L.Y. and Garland, S.M., 2017. Human papillomavirus vaccination: the population impact. F1000Research, 6.
  17. De Vincenzo, R., Conte, C., Ricci, C., Scambia, G. and Capelli, G., 2014. Long-term efficacy and safety of human papillomavirus vaccination. International journal of women’s health, pp.999-1010.
  18. Landy, R., Pesola, F., Castañón, A. and Sasieni, P., 2016. Impact of cervical screening on cervical cancer mortality: estimation using stage-specific results from a nested case–control study. British journal of cancer, 115(9), pp.1140-1146.
Sheetal DeCaria, M.D.
Sheetal DeCaria, M.D.
Written, Edited or Reviewed By: Sheetal DeCaria, M.D. This article does not provide medical advice. See disclaimer
Last Modified On:December 3, 2023

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