GOG 141

Treatment of (bulky) stage IB cervical cancer with or without neoadjuvant vincristine and cisplatin prior to radical hysterectomy and pelvic/para-aortic lymphadenectomy: a phase III trial of the Gynecologic Oncology Group.

Pubmed

Study Reviewed by: Anthony Costales

First Author: Eddy GL

Study hypothesis: Addition of neoadjuvant chemotherapy prior to radical hysterectomy in bulky IB cervical cancer improves survival

Standard Arm: Type III radical hysterectomy, pelvic/para-aortic lymph node dissection

Experimental Arm: Neoadjuvant vincristine 1 mg/m2 and cisplatin 50 mg/m2 every 10 days x 3 cycles followed by type III radical hysterectomy and pelvic & para-aortic lymph node dissection

Both arms:

If positive pelvic lymph nodes or parametrial margins: 45 Gy to pelvis LDR VBT to raise point A to 85 Gy and point B to 60 Gy

If positive para-aortic Lymph nodes: Extended field RT LDR VBT to raise point A to 85 Gy and point B to 60 Gy

Study population:
Inclusion: Squamous or adeno-, IB, tumor diameter ≥4 cm
Exclusion: prior pelvic radiation, prior chemo, prior hyst, no extrauterine mets

Primary endpoint: PFS, OS
Secondary endpoints: Toxicity, sites of recurrence
Arm distribution:

-Arm 1 (Rad Hyst): 143 (Squamous- 77%, adeno- 18%); Post surgical RT: 52%

-Arm 2 (NACT Rad Hyst): 145 (Squamous- 78%, adeno- 22%); Post surgical RT: 45%

Of note, 29% (48 pts) in the surgery arm received adjuvant treatment

Results

Outcome Rad hyst NACT Rad hyst P value
3 yr PFS 60.4% 59.7% NS
3 yr OS 69.3% 67.7% NS
Outcome Rad hyst NACT Rad hyst P value
5 yr PFS 53.8% 56.2% NS
5 yr OS 60.7% 63.3% NS
Adverse events Rad hyst NACT Rad hyst SS
G3/ GU 7% 1% Yes

Summary:

-NACT followed by radical hysterectomy did not improve PFS or OS as compared to radical hysterectomy alone.

-The GOG recommends, based on this study, against NACT for patients with stage IB2 cervical cancer.

-This study was closed early because of slow accrual, likely secondary to the Sedlis criteria publication

For bulky IB (≥4 cm) that undergo radical hysterectomy, approximately 50% will require adjuvant radiation

GOG 240

Improved Survival with Bevacizumab in Advanced Cervical Cancer

Pubmed             Free PMC article

Hypothesis: Addition of Bevacizumab improves overall survival

Site: Cervix

Experimental arm: Cisplatin (50mg/mg/m2) plus paclitaxel (135 or 175 mg/m2)
OR Topotecan (0.75 mg/m2 days 1,2,3) plus paclitaxel (175 mg/m2)

Standard Arm:Cisplatin (50mg/mg/m2) plus paclitaxel (135 or 175 mg/m2) Bevacizumab
OR Topotecan (0.75 mg/m2 days 1,2,3) plus paclitaxel (175 mg/m2) Bevacizumab

Primary Outcome: Overall Survival

Results:

Outcome Cis/Taxol OR Cis/Topo Cis/Taxol/Bev Or Cis/Topo/Bev p-value
Overall Survival (mths) 13.3 17 SS
Fatal adverse event % 1.8 1.8 NS
G3 fistula % 1 6 SS
G2 or higher HTN 2 25 SS
Febrile neutropenia % 5 5 NS
Thromboembolism % 1 8 SS

Conclusions: Adding Bevacizumab significantly improves OS in cervical cancer