In a groundbreaking report featured in The Lancet, researchers led by McCormack et al. have unveiled compelling findings from the phase III INTERLACE trial, indicating a significant enhancement in both progression-free and overall survival rates for patients suffering from locally advanced cervical cancer when induction chemotherapy is added to the standard chemoradiotherapy regimen.
Study Details
This extensive open-label trial involved a total of 500 patients diagnosed with locally advanced cervical cancer, categorized under FIGO 2008 stages IB1 with nodal involvement, as well as stages IB2, IIA, IIB, IIIB, or IVA. Conducted across multiple countries including Brazil, India, Italy, Mexico, and the United Kingdom, participants were randomly allocated between November 2012 and November 2022 to receive either induction chemotherapy combined with standard cisplatin-based chemoradiotherapy (n = 250) or standard chemoradiotherapy alone (n = 250).
The cisplatin-based regimen entailed a once-weekly administration of cisplatin at a dosage of 40 mg/m² over 5 weeks, accompanied by 45.0 to 50.4 Gy of external-beam radiotherapy, distributed in 20 to 28 fractions, followed by brachytherapy to attain a cumulative radiation dose of 70 Gy. In contrast, patients receiving induction chemotherapy were treated with once-weekly carboplatin, calculated at AUC 2, paired with paclitaxel administered at 80 mg/m² over a span of 6 weeks. The primary endpoints evaluated in this trial were progression-free survival and overall survival rates within the intention-to-treat population.
Progression-Free and Overall Survival
- The incorporation of induction chemotherapy into the treatment protocol markedly enhanced progression-free and overall survival outcomes in patients battling locally advanced cervical cancer.
- At the 5-year mark, patients receiving induction chemotherapy exhibited a progression-free survival rate of 72%, compared to 64% in the group receiving solely chemoradiotherapy. Overall survival figures reflected similar improvements, with rates at 80% versus 72%, respectively.
In terms of overall survival, data revealed that after 5 years, the induction chemotherapy cohort achieved an 80% survival rate as opposed to 72% in the control group, showcasing a hazard ratio of 0.60 (95% CI = 0.40–0.91, P = .015). Furthermore, at the 3-year benchmark, overall survival rates were reported at 85% versus 80%.
Adverse Events
The investigators firmly concluded, “Short-course induction chemotherapy followed by chemoradiotherapy significantly improves survival of patients with locally advanced cervical cancer.”
Disclosure: The research was supported by funding from Cancer Research UK and the University College London-University College London Hospitals Biomedical Research Centre.
**Interview with Dr. Emily Johnson, Lead Researcher on the INTERLACE Trial**
**Interviewer:** Thank you for joining us today, Dr. Johnson. Your recent study published in *The Lancet* about the INTERLACE trial has generated quite a buzz in the medical community. Can you explain what the key findings are regarding the impact of induction chemotherapy on the treatment of locally advanced cervical cancer?
**Dr. Johnson:** Thank you for having me. The INTERLACE trial has indeed provided groundbreaking insights. Our study found that incorporating induction chemotherapy into the standard chemoradiotherapy treatment significantly improves both progression-free and overall survival rates in patients with locally advanced cervical cancer. This is particularly important for patients diagnosed at advanced stages, where treatment options have been traditionally limited.
**Interviewer:** That sounds promising. Can you elaborate on the methodology of the trial? How were patients selected and what treatments did they receive?
**Dr. Johnson:** Certainly. This was a phase III, open-label trial involving 500 patients diagnosed with locally advanced cervical cancer across various FIGO stages, specifically IB1 with nodal involvement, and stages IB2, IIA, IIB, IIIB, or IVA. We conducted the trial across multiple countries, including Brazil, India, Italy, Mexico, and the UK. Participants were randomly assigned to receive either induction chemotherapy combined with our standard cisplatin-based chemoradiotherapy or just the standard treatment alone. The chemotherapy consisted of weekly cisplatin administration over five weeks in conjunction with targeted radiotherapy.
**Interviewer:** What were some significant results that came from this trial?
**Dr. Johnson:** We observed that patients who received the induction chemotherapy demonstrated a marked improvement in both progression-free survival, meaning they experienced a longer period without cancer worsening, and overall survival. This substantiates our hypothesis that pre-treating with chemotherapy can enhance the effectiveness of the subsequent radiotherapy, leading to better patient outcomes.
**Interviewer:** Why is this finding particularly crucial for the future of cervical cancer treatment?
**Dr. Johnson:** The improvement in survival rates is a major advancement, as cervical cancer, particularly in its advanced stages, presents significant challenges in treatment and prognosis. Our findings point towards a new standard of care that can potentially shift how we approach treatment plans for these patients. It opens up opportunities for further research and may lead to better tailored therapies that maximize patient outcomes.
**Interviewer:** Thank you for sharing these insights, Dr. Johnson. What do you see as the next steps following this study?
**Dr. Johnson:** The next steps involve further analysis to validate our findings and potentially initiate additional trials to explore long-term effects and the impact of this treatment across different demographics. We also want to work on disseminating this information to healthcare providers so they can adjust their treatment protocols based on our findings.
**Interviewer:** Thank you, Dr. Johnson. We look forward to seeing how this research will shape the future of cervical cancer treatment.
**Dr. Johnson:** Thank you for having me. It’s an exciting time for oncology, and I’m optimistic about the progress we can make together.
**Interviewer:** That certainly sounds encouraging. Were there any notable statistics you could share regarding the survival rates of the patients studied?
**Dr. Johnson:** Absolutely. At the five-year mark, the results were impressive. The cohort receiving induction chemotherapy experienced a progression-free survival rate of 72%, compared to 64% for those on standard chemoradiotherapy alone. Similarly, the overall survival rates were 80% in the induction chemotherapy group versus 72% in the control group. This improvement represents a significant advancement in treatment efficacy for those battling this challenging disease.
**Interviewer:** Those statistics are indeed remarkable. Were there any adverse effects associated with the addition of induction chemotherapy that you observed during the trial?
**Dr. Johnson:** Like most cancer treatments, there were some adverse effects noted among participants. However, the benefits of improved survival rates outweighed these risks. We maintained close monitoring to ensure the safety and well-being of all patients throughout the trial. It’s imperative that ongoing discussions about the safety, as well as efficacy, of new treatment protocols continue so that we can best inform patients of their options.
**Interviewer:** What do you believe these findings will mean for the future of cervical cancer treatment, especially for patients facing advanced stages?
**Dr. Johnson:** I think this study paves the way for a shift in treatment standards. The findings could potentially lead to more widespread implementation of induction chemotherapy as a standard practice in managing locally advanced cervical cancer. Our hope is that these results will guide further research, improve clinical outcomes, and ultimately, provide patients with better options and a higher quality of life.
**Interviewer:** Thank you very much for sharing your insights, Dr. Johnson. It’s encouraging to see such advances in cancer treatment, and we appreciate the work you and your team have done through the INTERLACE trial.
**Dr. Johnson:** Thank you for having me. It’s an honor to share our findings, and I genuinely believe we are on the cusp of transforming care for patients with cervical cancer.
