Phase I/II study of intravenous nedaplatin and intraarterial cisplatin with transcatheter arterial embolization for patients with locally advanced uterine cervical carcinoma

Comparison of Nedaplatin- and Cisplatin-Based Concurrent Chemoradiotherapy in Locally Advanced Cervical Cancer Patients: A Propensity Score Analysis

Purpose

The aim of this study was to evaluate the efficacy of using nedaplatin to replace cisplatin for concurrent chemoradiotherapy (CCRT) in patients with newly diagnosed locally advanced cervical cancer.

Methods

The medical records of 155 patients with cervical cancer who had undergone CCRT with cisplatin (n = 85) or nedaplatin (n = 70) between January 2012 and January 2017 were retrospectively reviewed. Propensity score analysis with 1:1 matching with the nearest neighbor matching method was performed to assess response rates, progression-free survival, overall survival, and toxicity between 2 groups.

Results

Propensity score matching identified 63 patients in each group. After matching, compared with patients treated with cisplatin-based concurrent chemoradiotherapy (CisRT), we found that patients treated with nedaplatin-based concurrent chemoradiotherapy (NedaRT) had a significant higher recurrence rate (25.4% vs 42.9%; P = 0.04). In addition, the 3-year progression-free survival rate for NedaRT group was also worse than that for the CisRT group (52.2% vs 63.4%, P = 0.03). There was no difference in the overall response rates between the CisRT and NedaRT groups (87.3% and 90.5%, respectively; P = 0.57). The rates of 3-year overall survival and grades 3 to 4 toxicities were similar between the 2 groups.

Conclusions

The clinical outcome of this cohort of patients with locally advanced cervical cancer treated with CCRT did in no way provide support for the use of nedaplatin in place of cisplatin in chemoradiation and demonstrated no equivalence of the 2 drugs. Cautions should be taken for the replacement among platinum complexes in cancer treatment.

Efficacy and Safety of Nedaplatin in Advanced Breast Cancer Therapy

PURPOSE

To compare the time-to-treatment failure (TTF), overall survival (OS), overall response rate (ORR), and adverse effects of regimens including nedaplatin- or cisplatin-based chemotherapy for advanced breast cancer (ABC).

METHODS

A total of 171 patients with ABC (admission between July 2008 and July 2013) were retrospectively analyzed. Patients received either nedaplatin 75 mg/m(2) (arm N; n = 85) or cisplatin 75 mg/m(2) (arm C; n = 86) in combination with other second-generation chemotherapeutic drugs, such as paclitaxel 175 mg/m(2), docetaxel 75 mg/m(2), gemcitabine 1.25 g/m(2), and navelbine 25 mg/m(2) every 21 days (nedaplatin, cisplatin, paclitaxel, docetaxel on day 1; gemcitabine, navelbine on days 1 and 8). The primary endpoint was TTF in each arm; secondary endpoints were OS, ORR, and toxicity.

RESULTS

In the assessable patient population, in arm N, median TTF and OS was 13.87 months (95% CI: 11.55-16.19) and 31.53 months (95% CI: 28.42-34.64), respectively, with an ORR of 48.2%. In arm C, median TTF and OS was 8.7 months (95% CI: 5.82-11.59) and 24.87 months (95% CI: 18.98-30.75), respectively, with an ORR of 37.2%. The occurrence of grades 3 and 4 hematologic toxicity was more frequent (45.9% vs. 25.6%, p = 0.003) in arm N than in arm C. However, grade ≥2 nonhematologic toxicity was less frequent in arm N than in arm C (12.9% vs. 46.5%, p = 2.05 × 10(-7)).

CONCLUSIONS

Nedaplatin-based chemotherapy regimen was well tolerated and efficiently improved patients' quality of life characterized by prolonged TTF and OS, with a marginal ORR.

Image-guided interventions in oncology

Interventional oncology, a term commonly used to indicate the minimally invasive procedures performed by interventional radiologists to diagnose and manage cancer, encompasses a broad spectrum of techniques unique to interventional radiology that have been established as a vital part of the multidisciplinary oncologic cancer care team. This article provides an updated overview of the variety of applications of image-guided procedures to distinct clinical scenarios, such as the diagnosis, treatment, and management of complications of malignancies.

Prognostic factors for locally advanced cervical cancer treated with neoadjuvant intravenous and transuterine arterial chemotherapy followed by radical hysterectomy

OBJECTIVE

The aim of this study was to identify prognostic factors associated with neoadjuvant transuterine arterial chemotherapy (TUAC) followed by type III radical hysterectomy.

METHODS

The medical histories of patients with stage IB2 to IIB cervical cancer who received neoadjuvant TUAC between 1996 and 2009 at our institution were retrospectively reviewed.

RESULTS

Seventy-three patients received TUAC using cisplatin combined with intravenous nedaplatin, irinotecan, paclitaxel, or etoposide administration. Forty-seven patients (64%) had squamous cell carcinoma. The radiological response rate was 96% (95% confidence interval, 91%-100%). Radical hysterectomy was completed for 95% of enrolled patients. Examination of the resected cervical specimens showed that tumor cells were absent in 19 cases and stromal invasion was less than 3 mm in 7 cases. Among these 26 patients, 23 (32%) had pathologically negative pelvic lymph nodes and no recurrence during the follow-up period. The 5-year relapse-free survival and overall survival rates were 69% and 74%, respectively. Among 23 patients with recurrence or progressive disease, the median survival time after recurrence or progression was 12 months. In multivariate analysis, a tumor size of more than 60 mm and pathological positive lymph nodes were negative prognostic factors for overall survival.

CONCLUSIONS

Tumor size, pathological response, and lymph node metastases were prognostic factors for cervical cancer. The high pathological response rate associated with TUAC makes it a promising treatment for bulky cervical cancer.

Intervention effects of nedaplatin and cisplatin on proliferation and apoptosis of human tumour cells in vitro

OBJECTIVE

To study synergistic effects of nedaplatin and cisplatin on three human carcinoma cell lines (esophageal carcinoma cell line Eca-109, ovarian carcinoma Skov-3 and cervical carcinoma Hela).

METHODS

Inhibition effects were evaluated by MTT assay and cell apoptosis was detected by flow cytometry. In addition, changes of Ki-67, Bax and Bcl-2 at mRNA and protein levels were quantified by RT-PCR and Western blotting.

RESULTS

Growth inhibition in each cell lines was dose-dependent after exposure to nedaplatin or cisplatin alone. The interaction of the two drugs was synergistic at higher concentrations according to the median-effect principle. The inhibition rates with nedaplatin, cisplatin and combined treatment were 41.9±4.1%, 47.4±2.9%, 52.5±0.9%(Eca-109), 39.0±1.26%, 45.0±1.45% , 56.2±1.44% (Skov-3) and 44.8±2.11%, 46.9±0.99%, 56.6±1.83% (Hela) respectively, with increase in apoptosis. Compared with the nedaplatin or cisplatin alone treatment group, the combinative treatment group's Ki-67 and bcl-2 mRNA (protein) expression was decreased while that of Bax mRNA (protein) was increased.

CONCLUSION

Compared to the effects of nedaplatin or cisplatin alone at high concentrations, combination of nedaplatin and cisplatin at low concentrations proved to be much more effective for inhibition of proliferation and the induction of apoptosis in the Eca-109, Skov-3 and Hela cell lines.

Long-term remission after multiple bone metastases following cervical cancer: A case report

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Multiple bone metastases following cervical cancer was completed resolved.

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Metastatic lesions were present within a previously irradiated zone of primary external radiation.

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Concurrent chemotherapy and bisphosphonate administration is promising.

Phase II trial on neoadjuvant intravenous and trans-uterine arterial chemotherapy for locally advanced bulky cervical adenocarcinoma

OBJECTIVE

A phase II trial on neoadjuvant trans-uterine arterial chemotherapy (TUAC) followed by type III radical hysterectomy (RH) was conducted for patients with bulky cervical adenocarcinoma (AC).

METHODS

Tumors of >4 cm were eligible. The neoadjuvant regimen comprised paclitaxel (60 mg/m(2) intravenously on days 1, 8, and 15) and cisplatin (70 mg/m(2) TUAC followed by transcatheter embolization with gelatin sponge particles on day 2) repeated every 3 weeks for 3 cycles. The primary endpoints were clinical and pathological responses.

RESULTS

Twenty-two patients (median age, 51 years; range, 33-75 years) were enrolled. The International Federation of Gynecology and Obstetrics stages were IB2 (9 patients), IIA-IIB (8), IIIB (3), and IVA (2). The adeno/adenosquamous ratio was 16/6. The overall clinical response rate was 95.4% (95% confidence interval [CI], 86.7-100%). RH was completed in 19 patients (86%), including 2 stage IVA patients who underwent anterior or posterior pelvic exenteration. Of the 19 patients, no residual malignant cells were found pathologically in 4; thus, the pathological complete response rate was 18% (4/22). No patients experienced grade 4 thrombocytopenia or febrile neutropenia or required platelet transfusions. The 5-year progression-free survival and overall survival rates in stages IB2-IIB were 70.0% (95%CI, 48.1-92.1%) and 69.5% (95%CI, 47.0-92.0%), respectively. The 2 patients with stage IVA tumors were alive without recurrence for 72 and 84 months after enrollment.

CONCLUSIONS

TUAC showed high clinical and pathological response rates. TUAC is promising for stage IB2-IIB and IVA bulky AC.

Fertility-Sparing Management for Bulky Cervical Cancer Using Neoadjuvant Transuterine Arterial Chemotherapy Followed by Vaginal Trachelectomy

Background

Fertility-sparing management for bulky cervical cancer remains under investigation. We investigated the safety of neoadjuvant transuterine arterial chemotherapy (TUAC) followed by a simple vaginal trachelectomy for patients with tumors larger than 3 cm in diameter who desired uterine preservation.

Methods

First, to assess the safety and efficacy of TUAC, survival and pathological complete response data from 39 patients with a diagnosis of stage IB2 to stage IIB cervical cancer who participated in 2 consecutive trials during 1997–2006 were analyzed. The neoadjuvant chemotherapy regimens were a combination of TUAC using cisplatin with intravenous nedaplatin or irinotecan. Second, to assess the safety of fertility-sparing management with TUAC, medical records of patients matching the following criteria were reviewed during the same period: (1) International Federation of Gynecology and Obstetrics stages IB1 to IIA; (2) maximum diameter of tumor, 3 cm or more; (3) squamous cell carcinoma; (4) no radiological findings of lymph node metastasis; and (5) patient’s strong desire for preservation of the uterus and to undergo TUAC.

Results

The overall 5-year survival rate of the 39 enrolled patients was 81.0% (95% confidence interval, 64.8%–93.7%). No malignant cells were found in pathologically examined surgical specimens from 14 patients (35.9%), all of whom were alive without recurrence for more than 7 years after treatment. Based on medical records, 7 patients were eligible according to the fertility-sparing criteria, 1 patient with International Federation of Gynecology and Obstetrics stage IB1 cancer, 5 patients with stage IB2, and 1 patient with stage IIA. One patient with stage IB1 cancer and 2 patients with stage IB2 cancer underwent simple vaginal trachelectomy, resection of paracervical tissues, and abdominal lymphadenectomy. Their disease-free intervals were 86, 120, and 65 months, respectively. All 3 patients had regular menses after surgery but no pregnancies, for personal reasons unrelated to fertility.

Conclusions

Powerful neoadjuvant chemotherapy regimens resulted in a pathological complete response. Long-term disease-free interval was achieved after fertility-sparing management for bulky cervical cancer in 3 cases.

Randomized Comparison of Intra-Arterial Chemotherapy Versus Intra-Arterial Chemotherapy and Gelfoam Embolization for Treatment of Advanced Cervical Carcinoma

PURPOSE

We evaluated the effects of intra-arterial infusion therapy by comparing the results obtained with a combination of intra-arterial anticancer drugs with and without transcatheter arterial embolization (TAE) in patients with cervical cancer.

METHODS

Between April 1999 and March 2003, intra-arterial therapy was administered to 45 patients (mean age 49 years) with cervical cancer. Of these, 18 had stage IIb , 4 had stage IIIa, 19 had stage IIIb, and 4 had stage IVb cancer; the histopathologic types were squamous cell carcinoma (n = 35), adenocarcinoma (n = 8), and adenosquamous carcinoma (n = 2). A total of 45 patients gave their informed consent and were randomized on a continuous basis into one of three groups according to the therapeutic protocols: group A consisted of 15 patients who received cisplatin, group B consisted of 17 patients who received cisplatin, mitomycin, doxorubicin hydrochloride, and 5-fluorouracil, and group C consisted of 13 patients who received cisplatin and TAE. Each protocol was administered twice with a 3 week interval between treatments. The efficacy of treatment was evaluated on the basis of the tumor reduction ratio (%) using MR imaging and the side effects were analyzed.

RESULTS

In groups A, B, and C, the tumor reduction ratio was 54%, 84%, and 86%, respectively; it was significantly greater in groups B and C than in group A (p < 0.01). The difference between groups B and C was not statistically significant. Although all group C patients developed severe pain after TAE, the pain was controlled with analgesics. Thrombocytopenia occurred in 6 of 17 (35%) group B patients.

CONCLUSION

Group B and C patients had better tumor reduction than those in group A. Fewer hematologic complications occurred in group C patients compared with group B.

Concurrent chemoradiotherapy with new platinum compound nedaplatin in oral cancer

Eleven patients with oral cancer were treated with the new platinum agent, nedaplatin, and 5-fluorouracil and simultaneous radiation therapy. The regimen was of 5 days' duration: 5-fluorouracil 400-500 mg/m(2) (days 1-5), nedaplatin 80-90 mg/m(2) (day 4), and a total radiation dose of 8-10 Gy (days 1-5). Of the 11 patients, 4 (36.4%) showed complete response and 5 (45.4%) showed partial response; the total response rate was 81.8%. Major side effects were hypochromia (27%), leukopenia (64%), granulocytopenia (55%), thrombocytopenia (36%), nausea and vomiting (82%), and mucositis (45%). Toxicity was grade 2 or less in most of the 11 patients. The results indicate that the regimen composed of combination chemotherapy with nedaplatin and radiation therapy is effective in the treatment of patients with squamous cell carcinoma of the oral region.