Combination Therapy Best For Cervical CancerAmy Norton
[Medical Tribune 40(6):4, 1999. ©]
Results of three studies released last month showing that radiation plus chemotherapy is more effective than radiation alone may change the way cervical cancer is treated, according to the National Cancer Institute.
In three of five NCI-sponsored phase III trials involving 1,283 women with cervical cancer, the proportion of women alive after three years was significantly higher in the groups receiving chemotherapy plus radiation than in those receiving only radiation.
"We're recommending to doctors that care be changed immediately," said Edward L. Trimble, M.D., head of the surgery section of the NCI's Cancer Therapy Evaluation Program. "Anyone who gets radiation should get chemotherapy plus radiation."
The importance of these findings prompted The New England Journal of Medicine to release the reports eight weeks ahead of its April 15 publication date.
In one study, led by Henry M. Keys, M.D., of Albany Medical College in New York, 83 percent of women who received weekly infusions of cisplatin with radiotherapy were alive three years after diagnosis, compared with 74 percent of women on radiation alone. All women had hysterectomies following therapy.
In another study, researchers led by Mitchell Morris, M.D., of the University of Texas M.D. Anderson Cancer Center in Houston, looked at the effects of a combination of cisplatin and 5-fluorouracil. Among women who received the drug combination plus radiation, the three-year survival rate was 76 percent, compared with 63 percent among women on radiation alone.
Furthermore, the third study suggested that cisplatin may beat other chemotherapy drugs in bolstering three-year survival. Researchers led by Peter Rose, M.D., of University Hospitals of Cleveland found that patients on cisplatin had a 65-percent survival rate, compared with a 47-percent rate among patients on radiation with concurrent hydroxyurea.
Overall, across all five trials, radiation plus concurrent chemotherapy with cisplatin (Platinol, Bristol-Myers Squibb) cut women's risk of death by 30 percent to 50 percent. The NCI has mailed a "clinical announcement" of the results to thousands of physicians.
Even though cisplatin improved survival rates in each of the trials, the NCI has not recommended it as the standard drug for cervical-cancer because, Dr. Trimble noted, there is not enough evidence to support such a recommendation.
The NCI also wants physicians to ensure that poorer and minority women get the routine Pap smears that can save their lives.