He cervical cancer It is the fourth most common in women and in 50% of cases it is caused by two types of human papillomavirus or HPV – 16 and 18 – according to the World Health Organization (WHO). Early diagnosis and treatment are key to improving your prognosis and, in fact, according to the WHO, 90% of the deaths caused by this disease in 2020 occurred in low- and middle-income countries, where the population does not have good access. health care.
The main challenges currently presented in the fight against cervical cancer are access to HPV vaccines and the fact that it is not always detected in its early stages, since in its beginnings this tumor is usually asymptomatic and only manifests itself when has progressed. For this reason, experts recommend that women undergo cytology periodically to detect its presence as soon as possible.
Now, a new scientific trial that has just been presented at the congress of the European Society for Medical Oncology (ESMO) can improve the prognosis of women with this type of cancer because its results reveal that use drugs that are already available before starting standard treatment can reduce the risk of the disease coming back or causing the patient’s death by about a third.
“A short course of additional chemotherapy given immediately before standard CRT can reduce the risk of cancer recurrence or death by 35%”
“Cervical cancer occurs in young women who are usually in the middle of their careers and have small children at home,” explained the professor. Krishnansu S. Tewari, director of the Gynecologic Oncology Program at the University of California, Irvine (USA), who adds: “Standard treatment leads to remission, but in two or three years the cancer can reappear. Two essays presented at the ESMO 2023 Congress reveal new ways to treat cervical cancer locally advanced cancer that significantly delay relapse, giving women in the prime of life more cancer-free time.”
Key advances in the treatment of cervical cancer
In one of the studies presented at ESMO (A randomized, double-blind, phase 3 ENGOT-cx11/GOG-3047/KEYNOTE-A18 study), 68% of women who received the immunotherapy drug pembrolizumab in addition to standard treatment were cancer-free at two years, compared with 57% of women who received placebo in addition to standard treatment.
The other study (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), which has achieved spectacular results, analyzed the impact of giving a combination of two different chemotherapy drugs before standard treatment with chemotherapy plus radiation, a strategy called induction chemotherapy.
In this phase III clinical trial, researchers studied whether a short course of induction chemotherapy (IC) using cheap, approved drugs to kill as many cancer cells as possible could reduce relapse rates and death if given before chemoradiation (CRT), a combination of chemotherapy and radiotherapy.
The results revealed that women with locally advanced cervical cancer who received induction chemotherapy were 35% more likely to be cancer-free at five years, and 39% more likely to be alive at five years compared to those who received only standard treatment. “Induction chemotherapy could be an accessible treatment option because These medicines are available all over the worldeven in low-income countries,” Tewari highlighted.
“Our trial shows that this short course of additional chemotherapy given immediately before standard CRT can reduce the risk of cancer recurrence or death by 35%. This is the greatest improvement in the results of this disease in more than 20 years,” says the doctora Mary McCormackprincipal investigator of the trial at the University College London (UCL) Cancer Institute and University College London Hospital.
The researcher stated that she is incredibly proud of all the cervical cancer patients who participated in the trial because “their contribution has allowed us to gather the evidence necessary to improve the treatment of cervical cancer patients around the world.” .
Cheap, accessible and available medicines worldwide
Over 10 years, 500 patients participated in INTERLACE in hospitals in the United Kingdom, Mexico, India, Italy and Brazil. These women had been diagnosed with cervical cancer that was large enough to be seen without the help of a microscope, but had not yet spread to other areas of the body. The average age of patients in the trial was 46 years.
Patients were randomly assigned to receive standard CRT (external radiation with cisplatin and weekly brachytherapy) or an initial six-week course of IC (chemotherapy with carboplatin and paclitaxel) followed by the same standard CRT described above. After five years, 80% of those who received IC plus CRT were alive and 73% had not experienced a cancer recurrence or tumor spread. In the standard treatment group, 72% were alive and 64% had not seen the cancer come back or spread. Carboplatin and paclitaxel, the drugs needed for IC, are cheap, accessible and already approved for use in patients, so the authors say they could be incorporated into standard treatment relatively quickly.
Professor Jonathan Ledermann, from the UCL Cancer Institute and one of the lead authors, said: “Cervical cancer is a disease that often affects women aged thirty or younger. Those with locally advanced disease have a relatively high chance of relapse and the disease can take a huge toll on patients and their families. This makes the results of the INTERLACE trial, which significantly improves overall survivalare an important advance in treatment.”
Dr Iain Foulkes, Executive Director of Research and Innovation at Cancer Research UK, said: “Timing is everything when treating cancer. “Simply adding induction chemotherapy to the start of chemoradiation treatment for cervical cancer has yielded remarkable results in this trial.” “We are excited about the improvements that this trial could bring to the cervical cancer treatment and we hope that short courses of induction chemotherapy will be rapidly adopted in the clinic,” he concludes.