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Six weeks of cheap chemotherapy before chemoradiation cut deaths by 40% (INTERLACE), while chemotherapy after chemoradiation did nothing (OUTBACK). Order matters.
Six weeks of carboplatin-based induction chemotherapy before definitive chemoradiation for locally advanced cervical cancer is a sequence pairing that improved survival in the phase 3 INTERLACE trial. By contrast, OUTBACK / ANZGOG 0902 / GOG-0274 gave adjuvant chemotherapy after chemoradiation and found no benefit but considerably more toxicity, so the order matters. The rationale is that induction achieves early systemic control of micrometastases while patients are still fit, whereas chemotherapy after radiation suffers from poor compliance and marrow toxicity. Because the induction drugs are cheap, the approach is deliverable in low- and middle-income countries where pembrolizumab is not, and it pairs with modern external beam radiotherapy and brachytherapy.
Shares INTERLACE, Brachytherapy, Cervical cancer, Carboplatin.
Shares OUTBACK / ANZGOG 0902 / GOG-0274, Locally advanced cervical cancer.
Shares Locally advanced cervical cancer, Brachytherapy, Cervical cancer.
Shares Locally advanced cervical cancer, Cervical cancer, Carboplatin.