Cementing cisplatin.

Top Line: Do we really need radiation and cisplatin to cure advanced cervical cancer?
The Study: Believe it or not, we don’t have great data for the use of concurrent cisplatin with radiation for the definitive treatment of advanced-stage cervical cancer. Until now. Results of an Indian phase 3 trial were reported last week: 424 women with FIGO IIIB cervical squamous cell carcinoma (SCC) were randomized to 50 Gy / 25 external beam radiation +/- weekly cisplatin, all with intracavitary interdigitated brachytherapy boost (30 Gy LDR or 7 Gy x 3 HDR). At 5 years, disease-free survival (DFS, 44% -> 52%) and overall survival (OS, 46% -> 54%) rates were significantly higher with the addition of chemo. This isn’t really surprising, but, while chemoradiation has been recommended since 1999 for these women, supporting trials had heterogenous populations. A UK meta-analysis indicated that stage III-IV cancers receive a diminished benefit with chemo, concluding with a call for an RCT. And now we have it.
Bottom Line: Yes, we really need cisplatin concurrent to definitive radiation for FIGO IIIB cervical cancer--a regimen now cemented as standard of care.

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