Neoadjuvant chemotherapy in cervical cancer: a new trend

Although there is effective screening for cervical cancer, it continues to be a healthcare problem in developing countries. To increase survival rates, different strategies with neoadjuvant chemotherapy have been developed. Nearly all trials that analysed neoadjuvant chemotherapy plus surgery demonstrated an improved outcome, but most phase III trials that compared neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone have failed to show further benefit. Recent data on neoadjuvant chemotherapy could change that assumption, so revision is needed.

A meta-analysis by the Medical Research Council (UK) based on individual patient data (2074 patients, median follow-up 5.7 years) showed that there was no benefit of survival in patients treated with radiotherapy. Some interesting results were obtained when the trials were grouped together according to cycle length and dose intensity. Trials that gave more intensive chemotherapy in terms of a shorter cycle or a higher dose intensity tended to show an advantage for neoadjuvant chemotherapy. When analysing neoadjuvant chemotherapy followed by surgery, data from meta-analysis showed a reduction in the risk of death of 35% and an absolute gain of 14% in the 5-year survival. The reasons for this could be that short cycle length chemotherapy was used in this subgroup or the surgery may have removed radioresistant cell clones.

Neoadjuvant chemotherapy may play a role in the treatment of women with cervical cancer. In future, it may be reasonable to compare it with concomitant chemoradiotherapy in terms of efficacy and toxicity.