The toxicity and long-term efficacy of nedaplatin and paclitaxel treatment as neoadjuvant chemotherapy for locally advanced cervical cancer.

BACKGROUND: The use of neoadjuvant chemotherapy (NACT) for the treatment of locally advanced cervical cancer (LACC) remains controversial. In current clinical practice, platinum-based chemotherapy is the major option for patients with LACC. However, serious adverse events have been reported after platinum-based chemotherapy treatment for LACC patients. In this study, the authors evaluated whether nedaplatin and paclitaxel (NP), as a new NACT regimen, offers less toxicity and better long-term efficacy for LACC (stages IB2-IIB) treatment. Comparisons between NP and paclitaxel and cisplatin (PC) in terms of toxicity and long-term efficacy are also presented.

METHODS: The authors retrospectively reviewed 252 consecutive patients with LACC, of whom 104 received NP; the others received PC. Toxicity was assessed according to the International WHO (1979) criteria for chemotherapy side effects, and the chi-squared test was used to identify whether there was a statistically significant difference in toxicity between the NP regimen and the PC regimen. A univariate and a Cox regression model were used to assess whether the patients who were administered NP were statistically significantly different from those who were administered PC with respect to the disease-free survival rate (DFS) and the overall survival rate (OS).

RESULTS: The overall response rate for NP and PC were 80.77% and 68.24%, respectively (P = 0.0267). The incidences of toxic reactions for NP and PC were 32.69% and 85.14%, respectively (P < 0.0001). The DFS for patients who were given the NP and the PC regimens were 81.41% and 67.28%, respectively (P = 0.014). The OS was 81.54% for patients who received the PC program and 93.89% for those who received the NP program (P = 0.0084). The NP program participants experienced a significant increase in the survival rate when compared to the group that received the PC program (DFS hazard ratio = 0.539, P = 0.0144 and OS hazard ratio = 0.354, P = 0.0077).

CONCLUSIONS: NP NACT followed by radical hysterectomy offers a higher response rate, lower incidence of toxic reactions and better long-term DFS and OS for patients with LACC compared with the chemotherapy regimen of PC followed by radical hysterectomy.