Neoadjuvant Chemotherapy And Surgical Resection vs Concomitant Chemoradiotherapy Did Not Improve OS Among Patients With Cervical Cancer

According to results from the phase 3 EORTC-55994 trial, the addition of neoadjuvant chemotherapy prior to surgical resection did not significantly improve 5-year overall survival (OS) compared to standard-of-care concomitant chemoradiotherapy among patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB2 to IIB cervical cancer. 

Currently there is “conflicting evidence on the value of neoadjuvant chemotherapy before surgery compared with concomitant chemoradiotherapy in stage IB2-IIB cervical carcinoma,” stated Gemma G. Kenter, MD, PhD, Amsterdam University Medical Center, Netherlands Cancer Institute, and coauthors. 

In this multi-center trial, 626 patients with FIGO stage IB2 to IIB cervical cancer were randomized to receive either neoadjuvant chemotherapy followed by surgery (n = 314), or standard-of-care concomitant chemoradiotherapy (n = 312). The primary end point was 5-year OS rate. Secondary end points included progression-free survival (PFS), OS, toxicity, and health-related quality of life (HRQOL). 

At a median follow-up of 8.7 years, 223 patients completed treatment in the surgical arm, 257 patients completed treatment in the standard of care arm, and 198 patients died. The 5-year OS rate was 72% in the surgical arm and 76% in the standard of care arm. In the surgical arm, 107 patients underwent additional radiotherapy and 20 patients in the standard of care arm underwent additional surgery. Short-term grade ≥3 adverse events occurred more frequently in the surgical arm while long-term grade ≥3 adverse events occurred more frequently in the standard of care arm. Treatment discontinuation was due to toxicity (9.6%) and progressive disease (6.7%) in the surgical arm and toxicity (7.4%) and patient refusal (4.2%) in the standard of care arm.

“This trial failed to demonstrate superiority in favor of the [neoadjuvant chemotherapy followed by surgery] arm but resulted in acceptable morbidity and HRQOL in both arms,” concluded Dr Kenter and coauthors. 

Associate editor of Journal of Clinical Oncology, Gini F. Fleming, MD, University of Chicago Medicine, Chicago, Illinois, pointed out, “Additional radiotherapy was used for a substantial proportion of patients with stage IB2 [to] IIB cervical cancer who were assigned to [neoadjuvant chemotherapy plus surgery] on this trial.” Dr Flemng went on, “[Concomitant chemoradiotherapy] remains the standard of care in this setting.” 

Source:

Kenter GG, Greggi S, Vergote I, et al. Randomized phase III study comparing neoadjuvant chemotherapy followed by surgery versus chemoradiation in stage IB2-IIB cervical cancer: EORTC-55994. J Clin Oncol. Published online: September 1, 2023. doi:10.1200/JCO.22.02852