Out and back.

Headline: More platinum-based chemo isn’t the answer for locally-advanced cervical cancer.

The Study: While definitive chemoradiation affords respectable local control for locally-advanced cervical cancer, the development of distant mets remains a common occurrence. However, attempts to improve outcomes with added chemo have fallen short. For instance, a phase 2 Brazilian trial from 2019 found worse survival when neoadjuvant chemo was given before CRT. The OUTBACK trial was a large randomized trial of 919 women with stage IB1-IVA cervical cancer. Results were presented at ASCO this week in abstract form. Women receiving definitive chemoradiation and brachytherapy were randomized to either observation or 4 cycles of adjuvant carbo/Taxol (what else?). Unfortunately, the addition of adjuvant chemo resulted in no difference in 5-year overall survival (72% vs 71%) or progression-free survival (63% vs 61%). There was also no difference in recurrence patterns with or without adjuvant chemo. In addition, the added chemo increased the rate of grade 3-5 toxicity from 62 to 81%.

TBL: We’ve gotta get more creative than carbo/Taxol to move the needle for survival for locally-advanced cervical cancer. | Mileshkin, ASCO 2021