New Treatment Cuts Disease-Related Death Risk

• A phase 3 clinical trial suggests a new standard of care for treating people with advanced cervical cancer.
• The recommendation includes a combination of induction chemotherapy followed by chemoradiotherapy.
• The researchers are interested in how future studies can investigate the use of immunotherapies to further improve survival rates.
• Clinicians are hopeful the new approach will give people with aggressive cervical cancer additional options for treatment, particularly those who face barriers to healthcare.

Cervical cancer affects approximately 11,500 people in the United States each year and 660,000 people worldwide.

A phase 3 clinical trial recently published in The Lancet proposes a new standard of care for people with cervical cancer who aren’t candidates for surgery. The recommendation includes a combination of induction chemotherapy followed by chemoradiotherapy instead of chemoradiotherapy alone.

Compared to participants who received only chemoradiotherapy, those who received both induction chemotherapy and chemoradiotherapy saw an increase from 64% to 72% in their 5-year progression-free survival rates.

The INTERLACE trial included 500 participants from medical centers in Brazil, India, Italy, Mexico, and the United Kingdom, all of whom had locally advanced cervical cancer.

“Prior to this study, doing chemotherapy before chemotherapy and radiation in combination had not really demonstrated benefit,” said Joshua G. Cohen, MD, medical director of the gynecologic cancer program at City of Hope Orange County, CA, told Healthline. Cohen wasn’t involved in the study.

“This was a large trial, an international trial [that] took over 10 years to complete, but certainly a study that gives us another option to offer patients, which is fabulous,” Cohen told Healthline.

The INTERLACE trial reduced the wait time between the initial course of induction chemotherapy and chemoradiotherapy, yielding promising results.

Study co-author and clinical oncologist Mary McCormack, PhD, told Healthline that while this updated approach has the support of many healthcare professionals, including those in the U.S., not everyone is on board with the new standard-of-care recommendation.

“I think some [concerns] lark back to the ’90s, when the older trials were published and demonstrated a detrimental effect of this approach by giving the chemotherapy,” McCormack said.

“There were a number of issues and potential flaws with those studies when they were all generally small studies and they all used different drug combinations and different schedules. They didn’t control for this interval between finishing the treatment, the chemo, and starting the radiation,” she explained.

The INTERLACE trial study was much broader, with participants spanning five different countries. Those who received both induction chemotherapy and chemoradiotherapy received 6 weeks of chemotherapy, with treatments occurring once a week.

Diana Pearre, MD, a gynecologic oncologist at The Roy and Patricia Disney Family Cancer Center at Providence Saint Joseph Medical Center in California, shared she is optimistic about the new treatment pathway. Pearre wasn’t involved in the clinical trial.

“I suspect many will read this study and think that this is a great way to start our patients on something,” she told Healthline.

“As clinicians, we are often made keenly aware of how different insurances, referrals, and other issues prevent our patients from starting radiotherapy on time. With over 70% of gynecologists also administrating chemotherapy, induction chemotherapy seems like something within our realm of control,” Pearre noted.

The drugs used in the INTERLACE trial are already broadly available, as are many of the quality-of-life treatments. Scalp cooling, for instance, can be used to combat the side effects of induction chemotherapy.

McCormack hopes to see clinicians make changes to improve cervical cancer treatment outcomes. She is also hopeful that ongoing research — like studies into the use of immunotherapies — could hold the key to even better treatment outcomes.

“I think the next step should be to look at incorporating and adding in immunotherapy with this induction treatment, because there’s good scientific rationale why this might work, and it’s an opportune moment to look at that now. And I do believe there are some groups in the US that are planning to do just that,” McCormack said.

Cohen agreed: “We’ve been looking for years in ways we can incorporate immunotherapy into the use of cervical cancer [treatments] because we all believe that cervical cancer should have an immune therapy treatment, given it’s largely driven by a virus, HPV,” he said, noting around 80% to 90% of cervical cancer is driven by HPV.

As with most medical treatments, access to the proposed standard of care and having it covered by health insurance is a key focus for the future.

While HPV vaccination and cancer screening efforts have increased over the decades, cervical cancer poses a higher risk to those in low-income countries and low-income areas.

While vaccination against HPV is vital to ongoing prevention and treatment efforts, Cohen said the findings of the study could lead to more options for those facing barriers to quality healthcare.

“If you’re in a place where you’re having a tough time getting a radiation oncologist to see you, or you’re getting delays in care, it’s a good option to start with chemotherapy,” he said.

“You have 6 weeks, you can get chemotherapy started, then maybe you get plugged in with the radiation oncologist. This is a good option now that we have data that says it works.”