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Incomplete cisplatin regimens in chemoradiation and its effect on outcomes for locally advanced cervical cancer
  1. Nikhil V Kotha1,
  2. Casey W Williamson2,
  3. Kyle V Marra1,
  4. Michael McHale3,
  5. Loren K Mell1 and
  6. Jyoti S Mayadev1
  1. 1Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
  2. 2Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA
  3. 3Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
  1. Correspondence to Dr Jyoti S Mayadev, Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California 92093, USA; jmayadev{at}ucsd.edu

Abstract

Objective To identify factors associated with receipt of incomplete cisplatin during chemoradiation for locally advanced cervical cancer and its impact on outcomes.

Methods Patients with locally advanced cervical cancer treated with chemoradiation at our institution between November 2015 and August 2020 were retrospectively identified. Patients who received ≤4 cycles were identified as the ‘incomplete’ cohort and those who received 5–6 cycles as the ‘complete’ cohort. The primary endpoint of incomplete chemotherapy was evaluated with multivariable logistic regression. Secondary endpoints of locoregional failure, overall survival, and distant failure were evaluated in multivariable Cox and Fine–Gray models.

Results Of 140 patients with locally advanced cervical cancer that underwent chemoradiation, 22 (15.7%) received an incomplete cisplatin regimen (8 with 0 cycles, 14 with 1–4 cycles). The most common reasons for receiving incomplete treatment were comorbidities/infections (41%), unmet laboratory parameters (27%), and cisplatin intolerance (14%). In multivariable models, only poor (2–4) Eastern Cooperative Oncology Group performance status was a significant predictor as these patients were 41 times more likely to receive incomplete chemotherapy (odds ratio (OR), 95% confidence interval (CI) 4.57 to 375.15, p<0.001). Median follow-up time was 20 months (range 4–64). In multivariable models, receipt of incomplete cisplatin was significantly associated with higher recurrence (locoregional failure hazard ratio (HR) 3.02, 95% CI 1.08 to 8.45, p=0.03; distant failure HR 2.71, 95% CI 1.13 to 6.47, p=0.02) and worse survival (overall survival HR 4.91, 95% CI 1.27 to 18.98, p=0.02).

Conclusion Incomplete cisplatin regimen was associated with worse oncologic outcomes. Poor performance status was the only factor associated with receiving an incomplete regimen. This notable proportion of patients may be a target for better tolerated novel targeted anticancer agents in order to improve outcomes.

  • Cervical Cancer

Data availability statement

Data are available upon reasonable request. Research data are stored in an institutional repository and will be shared on reasonable request to the corresponding author.

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Data availability statement

Data are available upon reasonable request. Research data are stored in an institutional repository and will be shared on reasonable request to the corresponding author.

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Footnotes

  • Twitter @NikhilVKotha

  • Contributors NVK: conceptualization, data curation, formal analysis, investigation, methodology, project administration, validation, visualization, and roles/writing-original draft. CWW: conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, software, validation, visualization, and writing-review and editing. KVM: formal analysis, investigation, and roles/writing-original draft. MM: resources, software, supervision, validation, and writing-review and editing. LKM: resources, software, supervision, validation, and writing-review and editing. JSM: guarantor, conceptualization, data curation, methodology, project administration, resources, software, supervision, validation, visualization, and writing-review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests LKM reports research grants from Merck; consultant fees from Bayer HealthCare; and other fees from Merck and ER Squibb & Sons outside the submitted work. JM serves as a consultant for Astra Zeneca, NRG Oncology, GOG Foundation, Varian Medical Systems, Primmune, and Merck; co-chair for NRG Oncology Cervix Co-Chair; and board member for GOG Foundation outside the submitted work.

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