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Chen J, Shi J, Cao Y, Li C, Li J, Yuan Z. A new treatment approach of toripalimab in combination with concurrent platinum-based chemoradiotherapy for locally advanced cervical cancer: A phase II clinical trial. Int J Cancer 2024. [PMID: 39340335 DOI: 10.1002/ijc.35206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 08/18/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024]
Abstract
This study investigated the efficacy and safety of toripalimab in combination with concurrent platinum-based chemoradiation in patients with untreated locally advanced cervical cancer. Eligible patients received toripalimab 240 mg once every 3 weeks in combination with concurrent platinum-based chemoradiotherapy, followed by the maintenance of toripalimab once every 6 weeks up to 1 year. The primary endpoint was objective response rate (ORR). Secondary endpoints included 2-year and 3-year progression-free survival (PFS) rates, 3-year overall survival (OS) rate, and safety. Biomarker analysis of PD-L1 expression and genomic mutational analysis by next-generation sequencing were conducted, as well as PD-L1 expression on tumor biopsies. A total of 82 patients were enrolled. The median follow-up was 21 months (range, 5.2-44.5 months). The ORR and disease control rate were both 87.8% among the 82 patients. Median PFS and OS were not reached. A trend toward longer PFS was observed in the populations with a PD-L1 combined positive score ≥10, low tumor mutation burden and loss of heterozygosity in human leukocyte antigen (HLA LOH) detected populations. A total of 37 patients experienced treatment-related adverse events, of which 17 (20.7%) patients experienced grade 3 or higher adverse events. Collectively, toripalimab plus concurrent platinum-based chemoradiotherapy showed promising antitumor efficacy with acceptable safety profiles in patients with untreated locally advanced cervical cancer.
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Affiliation(s)
- Jie Chen
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jinming Shi
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yuanjie Cao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Chen Li
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Junyi Li
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Zhiyong Yuan
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Zhang Y, Fan S, Shan M, Zou W, Feng Y, Hou T, Liu X, Wang J. Propensity score matching analysis to comparing cisplatin versus nedaplatin based doublet agent concurrent chemoradiotherapy for locally advanced cervical cancer. Sci Rep 2023; 13:9352. [PMID: 37291330 PMCID: PMC10250460 DOI: 10.1038/s41598-023-36433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/03/2023] [Indexed: 06/10/2023] Open
Abstract
This study evaluated the efficacy and safety of cisplatin and nedaplatin in three-week doublet agent concurrent chemoradiotherapy (CCRT) for patients with locally advanced cervical cancer (LACC). We retrospectively enrolled patients with stage IIB-IIIC2 cervical cancer who received doublet agent CCRT from January 2015 to December 2020. Clinical outcomes were analyzed using the Kaplan-Meier method and a Cox proportional hazards model. Propensity score (PS) matching analysis was used to compare cisplatin plus docetaxel group and nedaplatin plus docetaxel group. A total of 295 patients were included. The 5-year overall survival rate (OS) and progression free survival rate (PFS) were 82.5% and 80.4%, respectively. After PS matching, there were 83 patients each in the nedaplatin group and cisplatin group. There were no significant differences in objective response rates (97.6% and 98.8%, p = 0.212), 5-year OS rate (96.5 vs 69.8, p = 0.066), PFS rate (90.8 vs 72.4, p = 0.166), and toxicity between the two groups. Doublet agent concurrent chemoradiotherapy is feasible, safe, and shows high efficacy in LACC patients. Here, cisplatin group has a trend of better prognosis, suggesting that cisplatin is preferred and nedaplatin can be considered for replacement when cisplatin is intolerant.
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Affiliation(s)
- Yue Zhang
- Department of Oncology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Shasha Fan
- Department of Oncology, The First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Hunan, People's Republic of China
| | - Minjie Shan
- Department of Oncology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Wen Zou
- Department of Oncology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Yeqian Feng
- Department of Oncology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Tao Hou
- Department of Oncology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Xianling Liu
- Department of Oncology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Jingjing Wang
- Department of Oncology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China.
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Bacorro W, Baldivia K, Yu KK, Mariano J, Gonzalez G, Sy Ortin T. Outcomes with definitive radiotherapy among patients with locally advanced cervical cancer with relative or absolute contraindications to cisplatin: A systematic review and meta-analysis. Gynecol Oncol 2022; 166:614-630. [PMID: 35760651 DOI: 10.1016/j.ygyno.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The standard treatment for locally advanced cervical cancer (LACC) is chemoradiation (CRT) with cisplatin, followed by brachytherapy, but is less defined for cisplatin-intolerant patients. We synthesized evidence on treatment outcomes with definitive radiotherapy (RT) with or without chemotherapy (ChT) in these patients. METHODS We performed a systematic search and included 20 relevant studies. We extracted data on response, survival, compliance, and toxicity, and performed meta-analyses of outcome rates and risk ratios. Sensitivity and subgroup analyses were performed to explore sources of heterogeneity. Meta-regression was performed to examine the effects of other variables. RESULTS Due to lack of comparative data, most comparisons were indirect and derived from the proportional meta-analyses. Complete response (85%) and survival (62% 5yOS) rates are comparable to those published for LACC without contraindications to cisplatin. Survival rate is better with CRT than RT alone (5yOS, 73% vs 58%), and with nodal boost (NB) than without (5yOS, 71% vs 56%). Carboplatin CRT is associated with lower 5yOS (44%) but better ChT compliance (86%) when compared to other interventions. ChT compliance is better in renal failure than elderly cohorts (89% vs 67%). RT compliance is lower with CRT than RT alone (90% vs 96%), and higher with NB than none (96% vs 93%). NB is associated with lower RT compliance than no NB, when ChT is given. Meta-regression results affirm ChT and NB to be significant positive factors for survival, and NB, which is associated with greater use of advanced RT techniques, for RT compliance. CONCLUSION For those with relative contraindications, cisplatin CRT is effective and well-tolerated. For those with absolute contraindications, carboplatin is well-tolerated but with unclear effectiveness. Nodal boost is effective and well-tolerated, but is less tolerated when concurrent ChT is given.
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Affiliation(s)
- Warren Bacorro
- Department of Clinical Epidemiology, University of Santo Tomas, Faculty of Medicine and Surgery, Manila, Philippines; Department of Radiation Oncology, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Gynecologic Oncology Unit, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines.
| | - Kathleen Baldivia
- Department of Radiation Oncology, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Gynecologic Oncology Unit, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Kelvin Ken Yu
- Department of Radiation Oncology, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Gynecologic Oncology Unit, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Jocelyn Mariano
- Department of Obstetrics and Gynecology, University of Santo Tomas, Faculty of Medicine and Surgery, Manila, Philippines; Gynecologic Oncology Unit, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Gil Gonzalez
- Department of Obstetrics and Gynecology, University of Santo Tomas, Faculty of Medicine and Surgery, Manila, Philippines; Gynecologic Oncology Unit, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Teresa Sy Ortin
- Department of Radiation Oncology, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Gynecologic Oncology Unit, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
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Huang H, Nie C, Liu XF, Song B, Yue JH, Xu J, He J, Li K, Feng YL, Wan T, Zheng M, Zhang Y, Ye WJ, Li JD, Li YF, Li JY, Cao XP, Liu ZM, Zhang XS, Liu Q, Zhang X, Liu JH, Li J. Phase I study of adjuvant immunotherapy with autologous tumor-infiltrating lymphocytes in locally advanced cervical cancer. J Clin Invest 2022; 132:157726. [PMID: 35727633 PMCID: PMC9337833 DOI: 10.1172/jci157726] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Adoptive cell therapy (ACT) with tumor-infiltrating lymphocytes (TILs) has achieved remarkable clinical efficacy in metastatic cancers such as melanoma and cervical cancer (CC). Here we explored the safety, feasibility and preliminary tumor response and performed translational investigations of adjuvant immunotherapy using infusion of autogenous (auto)-TILs following concurrent chemoradiotherapy (CCRT) in CC patients with locally advanced disease. METHODS Twenty-seven CC patients with stage III to IV disease were recruited in this single-center, phase I study. TILs were isolated from lesions in the uterine cervix and generated under good manufacturing practices (GMP) conditions and then infused after CCRT plus intramuscular interleukin (IL)-2 injections. RESTULTS From 27 patients, TILs were successfully expanded from 20 patients, with a feasibility of 74.1%. Twelve patients received TILs following CCRT. Adverse events (AEs) were primarily attributable to CCRT. Only 1 (8.3%) patient experienced severe toxicity with a grade 3 hypersensitivity reaction after TIL infusion. No autoimmune AEs, such as pneumonitis, hepatitis, or myocarditis, occurred, and there was no treatment-related mortality. Nine of 12 patients (75.0%) attained complete response, with a disease control duration of 9 to 22 months. Translational investigation showed that the transcriptomic characteristics of the infused TIL products and some immune biomarkers in the tumor microenvironment and serum of CC patients at baseline were correlated with the clinical response. CONCULSION TIL-based ACT following CCRT was safe in an academic center setting, with potential effective responses in locally advanced CC patients. 'Hot' inflammatory immune environments are beneficial to the clinical efficacy of TIL-based ACT as adjuvant therapy. TRIAL REGISTRATION CLINICALTRIALS gov NCT04443296. FUNDING Natinoal Key R&D Program: Sci-Tech Key Program of the Guangzhou City Science Foundation; the Guangdong Provinve Sci-Tech International Key Program; the National Natural Science Foundation of China.
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Affiliation(s)
- He Huang
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Caiping Nie
- Department of Biotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiu-Feng Liu
- Department of Biotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bin Song
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Jian-Hui Yue
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Jingxiao Xu
- Department of Biotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jia He
- Department of Biotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Kui Li
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yan-Ling Feng
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ting Wan
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Min Zheng
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yanna Zhang
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wei-Jun Ye
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jun-Dong Li
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yan-Fang Li
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jun-Yun Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xin-Ping Cao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhi-Min Liu
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiao-Shi Zhang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qing Liu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xi Zhang
- BGI-Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Ther, BGI-Shenzhen, Guangzhou, China
| | - Ji-Hong Liu
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jiang Li
- Department of Biotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China
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Deng T, Gu S, Wu J, Yu Y. Comparison of platinum monotherapy with concurrent chemoradiation therapy versus platinum-based dual drug therapy with concurrent chemoradiation therapy for locally advanced cervical cancer: a systematic review and meta-analysis. Infect Agent Cancer 2022; 17:18. [PMID: 35440034 PMCID: PMC9019956 DOI: 10.1186/s13027-022-00433-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/11/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To compare the survival outcomes and adverse events of patients with locally advanced cervical cancer (LACC) who received platinum monotherapy with concurrent chemoradiation therapy (CCRT) versus platinum-based dual drug therapy with CCRT. Method All relevant literature was screened form the PubMed, EMBASE, Web of Science, The Cochrane Library and other databases from their establishment to October 2020. The main endpoint indicators included overall survival (OS) and progression-free survival (PFS). Grade 3 and above adverse events induced by chemotherapy were also compared. Results This study involved 17 literature and 4,106 patients. There were 2,066 patients treated with CCRT with platinum-based dual drug therapy and 2,040 patients received CCRT with platinum monotherapy. Meta-analysis results showed that, compared to CCRT with platinum monotherapy, OS (HR = 0.68, 95% CI 0.58–0.79) and PFS (HR = 0.67, 95% CI 0.58–0.77) of LACC patients were significantly improved by CCRT with platinum-based dual drug therapy. In addition, CCRT with platinum-based dual drug therapy led to more adverse reactions such as neutropenia (OR = 4.92, 95% CI 3.55–6.84), anemia (OR = 1.99, 95% CI 1.17–3.39), diarrhea (OR = 1.70, 95% CI 1.30–2.22), leukopenia (OR = 2.42, 95%CI 1.84–3.17), thrombocytopenia (OR = 2.87, 95%CI 1.44–5.72), etc. Conclusion CCRT with platinum-based dual drug therapy improved OS and PFS of LACC patients relative to the CCRT with platinum monotherapy. But it also increased the adverse reactions caused by multiple chemotherapy drugs. Thus, it is crucial to select a proper chemotherapy regimen based on the actual tolerance of patients in clinical practice.
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Affiliation(s)
- Ting Deng
- Department of Gynecology, The First People's Hospital of Chenzhou City, No.102, Luojiajing, Beihu District, Chenzhou City, 423000, Hunan Province, China
| | - Shequn Gu
- Department of Oncology, The First People's Hospital of Chenzhou City, Chenzhou City, 423000, Hunan Province, China
| | - Jianchi Wu
- Department of Gynecology, The First People's Hospital of Chenzhou City, No.102, Luojiajing, Beihu District, Chenzhou City, 423000, Hunan Province, China
| | - Yuanyi Yu
- Department of Gynecology, The First People's Hospital of Chenzhou City, No.102, Luojiajing, Beihu District, Chenzhou City, 423000, Hunan Province, China.
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The non-apoptotic function of Caspase-8 in negatively regulating the CDK9-mediated Ser2 phosphorylation of RNA polymerase II in cervical cancer. Cell Mol Life Sci 2022; 79:597. [PMID: 36399280 PMCID: PMC9674771 DOI: 10.1007/s00018-022-04598-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022]
Abstract
Cervical cancer is the fourth most frequently diagnosed and fatal gynecological cancer. 15-61% of all cases metastasize and develop chemoresistance, reducing the 5-year survival of cervical cancer patients to as low as 17%. Therefore, unraveling the mechanisms contributing to metastasis is critical in developing better-targeted therapies against it. Here, we have identified a novel mechanism where nuclear Caspase-8 directly interacts with and inhibits the activity of CDK9, thereby modulating RNAPII-mediated global transcription, including those of cell-migration- and cell-invasion-associated genes. Crucially, low Caspase-8 expression in cervical cancer patients leads to poor prognosis, higher CDK9 phosphorylation at Thr186, and increased RNAPII activity in cervical cancer cell lines and patient biopsies. Caspase-8 knock-out cells were also more resistant to the small-molecule CDK9 inhibitor BAY1251152 in both 2D- and 3D-culture conditions. Combining BAY1251152 with Cisplatin synergistically overcame chemoresistance of Caspase-8-deficient cervical cancer cells. Therefore, Caspase-8 expression could be a marker in chemoresistant cervical tumors, suggesting CDK9 inhibitor treatment for their sensitization to Cisplatin-based chemotherapy.
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How Macrophages Become Transcriptionally Dysregulated: A Hidden Impact of Antitumor Therapy. Int J Mol Sci 2021; 22:ijms22052662. [PMID: 33800829 PMCID: PMC7961970 DOI: 10.3390/ijms22052662] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
Tumor-associated macrophages (TAMs) are the essential components of the tumor microenvironment. TAMs originate from blood monocytes and undergo pro- or anti-inflammatory polarization during their life span within the tumor. The balance between macrophage functional populations and the efficacy of their antitumor activities rely on the transcription factors such as STAT1, NF-κB, IRF, and others. These molecular tools are of primary importance, as they contribute to the tumor adaptations and resistance to radio- and chemotherapy and can become important biomarkers for theranostics. Herein, we describe the major transcriptional mechanisms specific for TAM, as well as how radio- and chemotherapy can impact gene transcription and functionality of macrophages, and what are the consequences of the TAM-tumor cooperation.
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Ma S, Wang J, Han Y, Guo F, Chen C, Chen X, Zou W. Platinum single-agent vs. platinum-based doublet agent concurrent chemoradiotherapy for locally advanced cervical cancer: A meta-analysis of randomized controlled trials. Gynecol Oncol 2019; 154:246-252. [DOI: 10.1016/j.ygyno.2019.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 01/28/2023]
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Song D, Kong W, Zhang T, Han C, Liu T, Jiao S, Chen J. A retrospective analysis of cisplatin/carboplatin plus paclitaxel in advanced or recurrent cervical cancer. J OBSTET GYNAECOL 2019; 39:389-394. [PMID: 30663464 DOI: 10.1080/01443615.2017.1416595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To compare the efficacy and safety of paclitaxel plus carboplatin (TC) and paclitaxel plus cisplatin (TP) in the treatment of advanced or recurrent cervical cancer, this retrospective study included 116 advanced or recurrent cervical cancer cases treated at Beijing Obstetrics and Gynecology Hospital between June 2002 and June 2014. Of these cases, 52 were treated with TC (TC group) and 64 were treated with TP (TP group). We found that the overall survival and response and disease-control rates were not significantly different between the two groups. The TC group had a markedly lower incidence of Grade III-IV gastrointestinal toxicity reactions and a shorter hospitalisation stay than the TP group. The incidences of Grade III-IV bone marrow suppression and renal toxicity were not significantly different between the TP and TC groups. These findings suggest that TC may be a safe and effective alternative to TP for the treatment of advanced or recurrent cervical cancer. Impact Statement What is already known on this subject: Paclitaxel plus cisplatin (TP) is regarded as the standard regimen for cervical cancer, nevertheless, cisplatin is always associated with nephrotoxicity and requires hydration therapy. Carboplatin is a platinum analogue with milder nephrotoxicity than cisplatin. It is reported that carboplatin may be a viable and less toxic alternative to cisplatin in the management of advanced or recurrent cervical cancer, but another study shows that the therapeutic efficacy of paclitaxel plus carboplatin (TC) is non-inferior to that of TP. What the results of this study add: This study compared the efficacy and safety of TC and TP, and found that the TC and TP groups had similar overall response and disease-control rates and survival, but the TC group was better tolerated with a markedly lower incidence of Grades III-IV gastrointestinal toxicity reactions and had a shorter hospitalisation stay than the TP group. What the implications are of these findings for clinical practice and/or further research: TC may be a safe and effective alternative to TP for the treatment of advanced or recurrent cervical cancer in clinical practice.
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Affiliation(s)
- Dan Song
- a Department of Gynecological Oncology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Weimin Kong
- a Department of Gynecological Oncology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Tongqing Zhang
- a Department of Gynecological Oncology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Chao Han
- a Department of Gynecological Oncology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Tingting Liu
- a Department of Gynecological Oncology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Simeng Jiao
- a Department of Gynecological Oncology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Jiao Chen
- a Department of Gynecological Oncology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
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Xue R, Cai X, Xu H, Wu S, Huang H. The efficacy of concurrent weekly carboplatin with radiotherapy in the treatment of cervical cancer: A meta-analysis. Gynecol Oncol 2018; 150:412-419. [PMID: 29996970 DOI: 10.1016/j.ygyno.2018.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We aimed to evaluate whether carboplatin has a comparable efficacy with cisplatin as part of weekly concurrent chemoradiotherapy for cervical cancer (Car-RT vs. Cis-RT). METHODS A literature search was conducted and both prospective and retrospective studies that evaluated the efficacy of Car-RT for cervical cancer were included. The primary endpoints were complete response (CR) rate, progression-free survival (PFS)/disease-free survival (DFS), overall survival (OS), reported as odds ratios (ORs) and 95% confidence intervals (CIs). The estimated CR rate and survival of patients treated with Car-RT were pooled. Acute toxicity was also summarized. RESULTS Twelve studies consisting of 1698 patients were eligible for meta-analysis. A lower CR rate (OR, 0.53; 95% CI, 0.34-0.82, I2 = 0%) and a trend toward poorer 3-year PFS/DFS (OR, 0.71; 95% CI, 0.49-1.02, I2 = 0%) and 3-year OS (OR, 0.70; 95% CI, 0.46-1.05, I2 = 36%) were found in Car-RT compared with Cis-RT. For the Car-RT groups, the pooled overall CR rate was 81% (95% CI 0.74-0.89). The pooled 3-year PFS/DFS rate was 64% (95% CI 0.52-0.78). The pooled 3-year OS rate was 73% (95% CI 0.62-0.87). Acute toxic events ≥ grade 3 were infrequent in the Car-RT groups. CONCLUSIONS Car-RT showed a poorer tumor response and a trend toward inferior survival compared with Cis-RT in the treatment of cervical cancer. However, this evidence was limited by the imbalance among studies. Due to the encouraging efficacy and low toxicity, carboplatin is a suitable concurrent agent for patients with contraindications to cisplatin.
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Affiliation(s)
- Renliang Xue
- Department of Radiation Oncology, Shantou Central Hospital, Shantou, China
| | - Xiumei Cai
- Department of Intensive Care Medicine, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Hongyao Xu
- Department of Radiation Oncology, Shantou Central Hospital, Shantou, China
| | - Shengxi Wu
- Department of Radiation Oncology, Shantou Central Hospital, Shantou, China
| | - Hecheng Huang
- Department of Radiation Oncology, Shantou Central Hospital, Shantou, China.
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Tewari KS, Agarwal A, Pathak A, Ramesh A, Parikh B, Singhal M, Saini G, Sushma PV, Huilgol N, Gundeti S, Gupta S, Nangia S, Rawat S, Alurkar S, Goswami V, Swarup B, Ugile B, Jain S, Kukreja A. Meeting report, “First Indian national conference on cervical cancer management - expert recommendations and identification of barriers to implementation”. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2018. [PMCID: PMC6063013 DOI: 10.1186/s40661-018-0061-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Objective In India, cervical cancer accounts for almost 14% of all female cancer cases. Although poverty continues to cast a wide net over the Indian subcontinent, the preceding three decades have borne witness to improvements in nutrition and sanitation for many citizens. However, due to an absence of a national immunization program to cover human papillomavirus (HPV) vaccination and lack of accessible cervical cancer screening, the disease is characterized by late detection, lack of access to affordable and quality health care, and high mortality rates. Treatment of cervical cancer is stage-specific and depends on the patient’s age, desire to preserve fertility, overall health, the clinician’s expertise, and accessibility to resources. There is a paucity of uniform treatment protocols for various stages of cervical cancer in India. Considering all these parameters, a need to optimize treatment paradigms for the Indian population emerged. Methods/materials Three expert panel meetings were held in different regions of India from 2016 to 2017. They were comprised of 15 experts from across the country, and included surgical oncologists, radiation oncologists, and medical oncologists. The panel members reviewed the literature from both national and global sources, discussed their clinical experience and local practices and evaluated current therapeutic options and management gaps for women diagnosed with cervical cancer. Results This article summarizes the expert opinion from these meetings. It discusses the available resources and highlights the current therapeutic options available for different cervical cancer stages: early stage disease, locally advanced tumors, recurrent/persistent/metastatic cancer. An Indian consensus governing treatment options emerged, including guidelines for use of the only approved targeted therapy in this disease, the anti-angiogenesis drug, bevacizumab. Conclusions The panel concluded that given the availability of state-of-the-art imaging modalities, surgical devices, radiotherapeutics, and novel agents in several population-dense urban centers, a uniform, multi-disciplinary treatment approach across patient care centers is ideal but not realistic due to cost and a paucity of third party payors for most Indian citizens. Preventative strategies including visual inspection with acetic acid to screen for precursor lesions (i.e., cervical intraepithelial neoplasia) with immediate referral for cervical cryotherapy and possible large-scale roll-out of the HPV vaccine in the near future can be expected to reduce mortality rates significantly in this country.
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Chen Z, Shi Y, Wang S, Lu Q. Meta-analysis showing that early response to neoadjuvant chemotherapy predicts better survival among cervical cancer patients. Oncotarget 2017; 8:59609-59617. [PMID: 28938664 PMCID: PMC5601760 DOI: 10.18632/oncotarget.19425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 07/06/2017] [Indexed: 12/17/2022] Open
Abstract
This study was designed to identify the prognostic value of early response to neoadjuvant chemotherapy (NACT) for long-term survival of cervical cancer patients. We searched Pubmed and EMBASE for studies published through July 2016 on outcomes of cervical patients that received NACT. Eight studies involving 825 cervical cancer patients were ultimately included in our meta-analysis. We pooled the hazard ratios (HR) according to random-effects models and used funnel plots with Egger's and Begg's tests to explore potential publication bias. The HR between early response and 1-year overall survival (OS) was 3.60 (95% CI 1.93–6.72; I2 = 0). Similar results were found in the analysis of 3-year OS (HR 3.34; 95% CI 2.28–4.90; I2 = 0) and 5-year OS (HR 3.44; 95% CI 2.40–4.94; I2 = 0). Sensitivity analysis showed that all of the pooled results were robust, and all logHRs had confidence limits > 0. Our findings indicate that early response is associated with long-term survival, and responders achieved a higher survival rate than non-responders.
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Affiliation(s)
- Zhilan Chen
- Department of Obstetrics and Gynecology, Wuhan General Hospital of Guangzhou Military Command, Wuhan, Hubei, China
| | - Yachen Shi
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiping Lu
- Department of General Surgery, Wuhan General Hospital of Guangzhou Military Command, Wuhan, Hubei, China
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刘 健, 刘 静, 李 胜, 郑 迎, 郭 苏, 王 秀. [Inhibiting HSP70 expression enhances cisplatin sensitivity of cervical cancer cells]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2016; 37:475-481. [PMID: 28446399 PMCID: PMC6744087 DOI: 10.3969/j.issn.1673-4254.2017.04.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the relationship between sensitivity to cisplatin (DDP) and the expression of HSP70 in cervical cancer cells in vitro. METHODS Cervical cancer Hela229 cells treated with different concentrations of DDP and the HSP70 inhibitor (PFT-µ) were examined for cell viability using MTT assay and colony forming ability. The cell apoptosis was analyzed by flow cytometry with propidium iodide staining and DAPI staining, and JC-1 staining was used to determine mitochondrial membrane potential. The expressions of HSP70, Bcl-2, Bax and caspase-3 were measured with Western blotting. A nude mouse model bearing Hela229 cell xenograft was used to evaluate the effect of DDP and PFT-µ on tumor growth. RESULTS Hela229 cells expressed a higher level of HSP70 than normal cervical cells. The combined use of PFT-µ significantly enhanced the inhibitory effect of DDP (P<0.01) and increased the cell apoptosis in Hela229 cells. JC-1 staining demonstrated that DDP combined with PFT-µ more obviously reduced mitochondrial membrane potential. DDP combined with PFT-µ more strongly lowered Bcl-2 expression and increased the expressions of casepase-3 and Bax than DDP alone. In the nude mouse model, PFT-µ significantly enhanced DDP sensitivity of Hela229 cell xenografts (P<0.01). CONCLUSIONS Inhibition of HSP70 expression can enhance the sensitivity of cervical cancer cell to DDP both in vivo and in vitro possibly by promoting cell apoptosis, suggesting the potential of HSP70 as a new target for gene therapy of cervical cancer.
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Affiliation(s)
- 健 刘
- 蚌埠医学院药学院,安徽 蚌埠 233000Bengbu Medical College, Bengbu 233030, China
- 蚌埠医学院第一附属医院妇瘤科,安徽 蚌埠 233004Department of Gynecological Oncology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 静 刘
- 蚌埠医学院药学院,安徽 蚌埠 233000Bengbu Medical College, Bengbu 233030, China
- 蚌埠医学院第一附属医院妇瘤科,安徽 蚌埠 233004Department of Gynecological Oncology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 胜泽 李
- 蚌埠医学院药学院,安徽 蚌埠 233000Bengbu Medical College, Bengbu 233030, China
- 蚌埠医学院第一附属医院妇瘤科,安徽 蚌埠 233004Department of Gynecological Oncology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 迎奥 郑
- 蚌埠医学院药学院,安徽 蚌埠 233000Bengbu Medical College, Bengbu 233030, China
- 蚌埠医学院第一附属医院妇瘤科,安徽 蚌埠 233004Department of Gynecological Oncology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 苏阳 郭
- 蚌埠医学院药学院,安徽 蚌埠 233000Bengbu Medical College, Bengbu 233030, China
- 蚌埠医学院第一附属医院妇瘤科,安徽 蚌埠 233004Department of Gynecological Oncology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 秀 王
- 蚌埠医学院药学院,安徽 蚌埠 233000Bengbu Medical College, Bengbu 233030, China
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