A new study published in The Lancet demonstrates that adding six weeks of induction chemotherapy (IC) to the standard chemoradiotherapy (CRT) significantly improves survival rates for women with locally advanced cervical cancer. The international phase III trial, named INTERLACE, found that this approach reduces the risk of death by 40% and cancer recurrence by 35% over a five-year follow-up period.
Key Findings from the INTERLACE Trial
The INTERLACE trial, conducted across 32 medical centers in Brazil, India, Italy, Mexico, and the UK, involved 500 patients with locally advanced cervical cancer. Patients were randomized to receive either standard chemoradiotherapy (CRT) with cisplatin or six weeks of induction chemotherapy (IC) using carboplatin and paclitaxel, followed by the same CRT regimen.
The results indicated that 80% of patients in the IC plus CRT group were alive after five years, compared to 72% in the CRT-only group. Furthermore, 72% of patients in the IC plus CRT group experienced no cancer recurrence or spread, compared to 64% in the CRT-only group. Dr. Mary McCormack, lead investigator from UCL Cancer Institute, emphasized that this represents the biggest improvement in outcome in this disease in over 20 years.
Impact on Clinical Practice
The study suggests that incorporating induction chemotherapy before chemoradiotherapy should be considered a new standard of care for locally advanced cervical cancer. According to Professor Jonathan Ledermann from UCL Cancer Institute, the incremental cost for using the drugs in the INTERLACE trial is low, making this a new treatment that can be easily implemented in all health economies, to significantly improve overall survival.
Dr. Iain Foulkes, Executive Director of Research and Innovation at Cancer Research UK, noted that the study highlights the value of additional rounds of chemotherapy before other treatments like surgery and radiotherapy in several other cancers. He added that this approach can reduce the chances of cancer coming back and can be delivered quickly using drugs already available worldwide.
Adverse Events and Considerations
While the addition of induction chemotherapy showed significant benefits, it also came with increased side effects. The trial reported that 59% of patients in the IC plus CRT group experienced severe or life-threatening adverse events, compared to 48% in the CRT-only group. Common adverse events included fatigue, gastrointestinal problems, infections, and low white blood cell counts. Researchers recommend careful monitoring of blood counts with this treatment regimen.
Cervical Cancer Burden and Prevention
Cervical cancer, often caused by human papillomavirus (HPV), remains a significant health concern for women. In the UK, approximately 3,200 new cases are diagnosed each year, with a five-year survival rate of around 70%. The development of HPV vaccines and screening programs has significantly reduced the incidence and mortality rates of cervical cancer. According to Dr. Otis Brawley, a professor of oncology at Johns Hopkins University, cervical cancer is almost totally preventable with either the HPV vaccine or screening.
Future Directions
The INTERLACE trial opens avenues for further research, including the potential addition of immunotherapy to the chemotherapy and chemoradiation regimen to improve survival further. As noted by Dr. Diana Pearre, a board-certified gynecologic oncologist, it will be pivotal to examine which group in this locally advanced benefit can benefit most from this approach.
