6 Weeks of Induction Chemotherapy Before CRT Increases Cervical Cancer Survival Rate

Scientists are continually looking for cancer treatments that improve patients’ quality of life and reduce their fatality risk.

The results of a study about a new cervical cancer treatment suggest significant progress in these goals.

Cervical Cancer’s Global Impact

Cervical cancer is the fourth most common cancer among females. The World Health Organization’s most recent data on the matter recorded approximately 604,000 new cases and 342,000 deaths from the disease in 2020. Additionally, diagnoses and fatalities are most common among women living in low and middle-income countries, or those who have HIV.

Treatment options depend on the type of cervical cancer and the extent of its spread. Doctors may recommend surgical removal of malignant tissue, or radiation and chemotherapy to destroy it.

Administering Induction Chemotherapy Before Chemoradiation

Results published in October 2023 detailed the results of a collaborative effort from University College London and University College London Hospitals that investigated a new cervical cancer treatment. The work occurred within a 500-patient, phase III trial spanning a decade. It assessed the effectiveness of some participants receiving six weeks of induction chemotherapy before chemoradiation therapy (CRT).

Induction chemotherapy is an intensive, first-line treatment that can improve the survival rates for some patients. Its goal is to destroy as many cancer cells as possible. Then, as the name suggests, chemoradiation therapy involves people simultaneously receiving chemotherapy and radiation.

These two treatments destroy tumors through different methods — chemotherapy relies on killing them with anti-cancer drugs, while radiation uses high-energy rays. Since chemotherapy drugs can make the cancer cells more reactive to radiation, these two treatments are often more effective than either one by itself.

Working Toward Improvements

Researchers elsewhere have also explored antibody-drug conjugates as chemotherapy alternatives. One downside of chemotherapy is it destroys healthy cells along with harmful ones. Antibody-drug conjugates could provide a more targeted approach.

Coverage of the study noted how CRT has been the standard cervical cancer treatment in the United Kingdom since 1999. However, despite radiation therapy methods improving in that time frame, 30% of patients with cervical cancer find their disease ultimately returns after successful rounds of treatment. The likelihood of patients surviving at least five years from their initial diagnosis is 70% — a percentage scientists understandably want to keep raising.

The high-risk human papillomavirus (HPV) causes almost all cervical cancer cases. Additionally, estimates suggest up to 10% of the world’s population has active cervical HPV infections at any time. However, the body naturally rids itself of almost 90% of infections within a year or two. Plus, the high availability of cervical cancer screenings and the HPV vaccine make the disease largely preventable.

Even so, research such as this study is instrumental for those affected by it. The UCL and UCLH research team investigated whether a short course of induction chemotherapy before the standard CRT treatment would improve survival rates and reduce the likelihood of relapse. 

Who Participated in the Trial, and What Was Involved?

Patients invited to take part in the trial were all diagnosed with cervical cancer that was large enough for microscopic detection that had not yet spread elsewhere in the body. All participants were receiving hospital care at facilities in the United Kingdom, India, Brazil, Italy and Mexico, and their median age was 46.

The researchers randomly selected patients to receive a six-week course of induction chemotherapy followed by standard CRT for five weeks or to have the standard CRT treatment with no induction therapy. More specifically, the standard CRT plan involved patients getting external radiation with weekly cisplatin doses. It contains platinum and causes irreparable damage to the DNA of replicating cells. Patients getting the standard CRT plan also received brachytherapy — a type of internal, localized treatment where administrators place a sealed radiation source close to the cancer. 

The participants allocated to the six-week course of induction chemotherapy received carboplatin and paclitaxel before the methods above. Carboplatin is another platinum-containing drug designed to kill rapidly growing cells by damaging their DNA. Finally, paclitaxel is a drug administered by intravenous injection that blocks the division of cancerous cells.

What Did the Study Results Show?

When researchers looked at patient outcomes after five years, 80% of those who received the induction therapy with the standard CRT were still alive. Additionally, 73% of those did not have their cancer return or spread within that time frame. In contrast, 72% of those in the standard CRT group were still living after five years, and 64% had not experienced the recurrence or spread of their cancer.

A Cervical Cancer Treatment With Potential

Trial lead investigator Dr. Mary McCormack said these results represented the biggest outcome-based improvement from a cervical cancer treatment in more than 20 years. The drugs used for the induction chemotherapy phase of this trial are also inexpensive, approved for human use and accessible, making them relatively simple to integrate into a patient’s treatment plan.