Factors Used for Prognosis in Advanced Cervical Cancer

Article

A new study yielded nomograms for the assessment of locally advanced cervical cancer, with prognostic factors including histology, performance status, and others.

A new study yielded nomograms for the assessment of locally advanced cervical cancer. These tools included prognostic factors such as histology, performance status, and others.

The National Comprehensive Cancer Network’s guidelines currently include chemoradiotherapy as the standard for treatment of locally advanced cervical cancer. “The current Gynecologic Oncology Group [GOG] ancillary data study was undertaken to evaluate prognostic factors for locally advanced cervical cancer treated in the era of cisplatin-based chemoradiotherapy,” wrote study authors led by Peter G. Rose, MD, of the Cleveland Clinic Foundation.

The researchers retrospectively reviewed 2,042 patients with locally advanced cervical carcinoma who were enrolled in GOG clinical trials of concurrent cisplatin-based chemotherapy and radiotherapy. Nomograms were created for 2-year progression-free survival (PFS), 5-year overall survival (OS), and pelvic recurrence. Results were published online ahead of print on March 2 in the Journal of Clinical Oncology.

The nomograms assigned points for a variety of factors, and then correlated the total points to predicted probability of the outcome. These factors included: histology, race/ethnicity, performance status, tumor size, FIGO stage, grade, pelvic nodes, and specifics of treatment received. The race/ethnicity factor was significant for both 2-year PFS and 5-year OS largely because poorer outcomes among African American patients, and improved OS among Asians.

The 2-year PFS nomogram had a bootstrap-corrected concordance index of 0.62, and the 5-year OS nomogram had a concordance index of 0.64; authors noted that both were well calibrated.

The researchers also removed several non-significant factors and created a nomogram for pelvic recurrence. The bootstrap-corrected concordance index for this nomogram was 0.73 and was again well calibrated.

“Accurate estimation of survival for patients receiving a cancer diagnosis based on patient and tumor characteristics permits critical stratification in clinical trials and offers the possibility of tailoring the aggressiveness of treatment to the individual situation,” the authors wrote. Previous reports of survival in cervical cancer have relied solely on disease stage, but in this cohort, stage alone accounted for only about 60% of the prognostic information, with the rest coming from the other factors studied.

Cohort Details

The majority of patients in the cohort had squamous cell carcinoma (88.7%). Most also had a performance status of 0 (72.1%), and 60.8% of the total group were white. Most people did receive cisplatin-based chemoradiotherapy (65%).

Related Videos
Developing novel regimens may continue to improve survival outcomes of patients with advanced cervical cancer following the FDA approval of pembrolizumab and chemoradiation, says Jyoti S. Mayadev, MD.
Treatment with pembrolizumab plus chemoradiation appears to be well tolerated with no detriment to quality of life among those with advanced cervical cancer.
Jyoti S. Mayadev, MD, says that pembrolizumab in combination with chemoradiation will be seamlessly incorporated into her institution’s treatment of those with FIGO 2014 stage III to IVA cervical cancer following the regimen’s FDA approval.
Despite the addition of a TIGIT inhibitor to a checkpoint inhibitor resulting in high levels of safety, there is no future for that combination alone, according to Ritu Salani, MD.
Treatment with tisotumab vedotin may be a standard of care in second- or third-line recurrent or metastatic cervical cancer, says Brian Slomovitz, MD, MS, FACOG.
Domenica Lorusso, MD, PhD, says that paying attention to the quality of chemoradiotherapy is imperative to feeling confident about the potential addition of pembrolizumab for locally advanced cervical cancer.
Guidelines from the Society of Gynecologic Oncology may help with managing the ongoing chemotherapy shortage in the treatment of patients with gynecologic cancers, according to Brian Slomovitz, MD, MS, FACOG.
Brian Slomovitz, MD, MS, FACOG, notes that sometimes there is a need to substitute cisplatin for carboplatin, and vice versa, to best manage gynecologic cancers during the chemotherapy shortage.
Related Content