Cancer Res Treat.  2022 Apr;54(2):554-562. 10.4143/crt.2021.375.

Effectiveness of Concomitant Chemoradiotherapy with Gemcitabine in Locally Advanced Cervical Cancer Patients with Comorbidities

• Brau-Figueroa H
• Arango-Bravo E
• Castro-Eguiluz D
• Galicia-Carmona T
• Lugo-Alferez LA
• Cruz-Bautista I
• Jiménez-Lima R
• Cetina-Pérez L

• KMID: 2528224
• DOI: http://doi.org/10.4143/crt.2021.375

Abstract

Purpose
The standard treatment for locally advanced cervical cancer (LACC) is concomitant chemoradiotherapy with cisplatin (CDDP) followed by brachytherapy. The presence of comorbidities are risk factors for nephrotoxicity and are associated with lower survival. Gemcitabine is a radiosensitizing drug that has shown efficacy and safety in this context. The effectiveness of concomitant chemoradiotherapy with gemcitabine was evaluated versus cisplatin in LACC patients with comorbidities and preserved renal function.
Materials and Methods
An observational, longitudinal and paired study was carried out that included patients treated between February 2003 and December 2015. The primary objectives were to evaluate response rates, progression-free survival, and overall survival; the secondary objectives were to evaluate toxicity and renal function.
Results
Sixty-three patients treated with gemcitabine at 300 mg/m² weekly and 126 patients treated with CDDP 40 mg/m² weekly were included. There were no significant differences in response rates and survival rates. Treatment with cisplatin presented a higher frequency of hematological toxicities, while gemcitabine presented a higher frequency of gastrointestinal toxicities. A decrease in glomerular filtration rate (GFR; baseline vs. 1-year post-treatment) was observed in the cisplatin group (p=0.002), while not in the gemcitabine group (p=0.667). In a multivariate analysis, it is observed that only CDDP correlates with the decrease in GFR (hazard ratio, 2.42; p=0.012).
Conclusion
In LACC patients with comorbidities, gemcitabine and CDDP show the same efficacy, with different toxicity profiles. Treatment with cisplatin is associated with a significant decrease in GFR during follow-up, compared to treatment with gemcitabine that does not decrease it.

Keyword

Locally advanced cervical cancer; Comorbidities; Nephrotoxicity; Gemcitabine

Figure

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  Fig. 1 Study population. An observational, longitudinal, paired and retrolective study was carried out that included locally advanced cervical cancer (LACC) patients with comorbidities treated between February 2003 and December 2015. Patients treated with gemcitabine were paired by age and clinical stage with patients treated with cisplatin. CC, cervical cancer; CT-RT, concomitant chemoradiotherapy.

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  Fig. 2 (A) Overall survival of patients treated with gemcitabine (red line) and patients treated with cisplatin (blue line). Overall survival was estimated by the Kaplan-Meier method, using log-rank. (B) Progression-free survival of patients treated with gemcitabine (red line) and patients treated with cisplatin (blue line). Progression-free survival was estimated by the Kaplan-Meier method, using log-rank.

Reference

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