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Patterns of use of primary and first-line chemotherapy for recurrence among patients with cervical cancer
  1. Alexandra Diggs1,2,
  2. Yongmei Huang1,
  3. Alexander Melamed3,
  4. Elizabeh Szamreta4,
  5. Matthew Joseph Monberg4,
  6. Dawn Hershman1,2,4 and
  7. Jason D Wright1,2,4
    1. 1 Columbia University College of Physicians and Surgeons, New York, New York, USA
    2. 2 New York Presbyterian Hospital, New York, New York, USA
    3. 3 Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
    4. 4 Merck & Co Inc, Rahway, New Jersey, USA
    1. Correspondence to Dr Jason D Wright, Obstetrics and gynecology, Columbia University, New York, NY 10032, USA; jw2459{at}


    Background Little is known about real-world patterns of chemotherapy use in patients with cervical cancer.

    Objective To examine the patterns of chemotherapy use in patients with cervical cancer

    Methods We identified patients with cervical cancer in the IBM MarketScan Database who underwent primary hysterectomy or radiation therapy between 2011 and 2020 and described their treatment in the primary setting and at first recurrence.

    Results We identified 5390 patients: 2667 (49.5%) underwent primary hysterectomy and 2723 (50.5%) primary radiotherapy. Among patients who underwent primary hysterectomy, 979 (36.7%) received adjuvant radiation, and 617 (23.1%) received primary chemotherapy. The most common chemotherapy regimens were single-agent platinum (51.7%), platinum combination therapy (42.9%), and non-platinum (3.4%). Among patients treated with primary radiation, 73.6% received primary/concurrent chemotherapy, either platinum alone (66.4% of those who received chemotherapy), platinum combinations (32.2%), or non-platinum (1.4%). The median duration of primary chemotherapy was 1.2 months. Therapy for recurrent cervical cancer was initiated in 959 patients. The most common regimens were platinum combination (63.9%), non-platinum cytotoxic agents (16.5%), single-agent platinum (14.9%), targeted therapy with bevacizumab (6.0%), and immunotherapy with pembrolizumab (3.2%). Overall, the proportion of patients treated with single-agent platinum therapy increased from 17.4% in 2011 to 32.1% in 2019, while platinum combinations decreased from 64.1% to 41.5% over the same years. Use of non-platinum agents increased from 18.5% in 2011 to 32.9% in 2018 and 26.4% in 2019.

    Conclusions Platinum-based chemotherapy is the most commonly used therapy in patients with cervical cancer in the primary setting and at the time of recurrence. The rate of use of non-platinum agents at first recurrence has increased over time.

    • Cervical Cancer
    • Cervix Uteri

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    • Contributors Conception: JDW, ES, MJM. Design: JDW, YH, ES, MJM. Analysis: AD, YH, AM, ES, MJM, DH, JDW. Manuscript drafting: AD, YH, JDW. Manuscript review: AD, YH, AM, ES, MJM, DH, JDW. Final approval of manuscript: AD, YH, AM, ES, MJM, DH, JDW. Guarantor: JDW.

    • Funding Funding for the study was provided by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA.

    • Competing interests JDW has received royalties from UpToDate. ES and MJM are employees and stockholders of Merck.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.