(P001) Triapine Radiochemotherapy Improves Survival in Women With Stage IIIb Cervical Cancer

April 15, 2014
Oncology, Oncology Vol 28 No 1S, Volume 28, Issue 1S

Findings suggest that triapine radiochemotherapy provides improved cancer-related survival in women with stage IIIB cervical cancer.

Charles A. Kunos, MD, PhD, Tracy Sherertz, MD; Case Western Reserve University; Summa Health System; University Hospitals of Cleveland

Purpose: The Surveillance, Epidemiology and End Results (SEER) registry has published a 3-year cancer-related survival rate of 55% among the 2,236 cases of stage IIIB squamous cell cervical cancer between 1988 and 2001. Triapine irreversibly blocks ribonucleotide reductase, the de novo rate-limiting generator of DNA building blocks, and enhances cytotoxic effects of cisplatin chemotherapy and radiation therapy. Whether triapine radiochemotherapy reduces extrapelvic disease progression and disease-related death is not known.

Materials and Methods: Between 2006 and 2011, 12 women with clinical stage IIIB cervical cancer underwent three-times-weekly intravenous triapine (25 mg/m2), once-weekly cisplatin (40 mg/m2), and daily pelvic irradiation (45 Gy) followed by brachytherapy (30–40 Gy) on phase I and phase II trials. Lymph node positivity was determined by CT and positron emission tomography (PET) with [18F]-fluoro-2-deoxy-D-glucose (FDG). Cancer-related survival was evaluated by the Kaplan-Meier method.

Results: Median follow-up was 30 months (range: 4–90 mo). Pretherapy FDG-PET/CT detected abnormal FDG uptake in pelvic lymph nodes in 9 (75%) of the 12 stage IIIB women. One local (8 mo) and three distant (5, 23, and 24 mo) relapses have occurred after triapine radiochemotherapy. Two (17%) cervical cancer-related deaths and two (17%) non–cancer-related deaths have been observed. The 3-year cancer-related survival rate for women with stage IIIB cervical cancer was 74% (95% confidence interval [CI], 58%–90%), which compares favorably with a 55% SEER control.

Conclusions: Findings suggest that triapine radiochemotherapy provides improved cancer-related survival in women with stage IIIB cervical cancer. A prospective National Cancer Institute–sponsored (NCT01835171) randomized phase II trial of triapine radiochemotherapy vs radiochemotherapy has begun accrual nationwide.