Neoadjuvant chemotherapy prior to radical hysterectomy in locally advanced cervical cancer: a systematic review and meta-analysis

Chiara Borghi; Elena Biagioli; Jessica Mauro; Anna Roberto; Martina Borghese; Alessandro Buda

doi:10.1136/ijgc-2023-004863

Neoadjuvant chemotherapy prior to radical hysterectomy in locally advanced cervical cancer: a systematic review and meta-analysis

Int J Gynecol Cancer. 2023 Nov 27:ijgc-2023-004863. doi: 10.1136/ijgc-2023-004863. Online ahead of print.

Authors

Chiara Borghi¹, Elena Biagioli², Jessica Mauro^{1

3}, Anna Roberto², Martina Borghese⁴, Alessandro Buda⁵

Affiliations

¹ Division of Gynecology Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Piedmont, Italy.
² Research, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy.
³ University of Udine, Udine, Italy.
⁴ Division of Obstetrics and Gynecology, Ospedale Santa Croce, Cuneo, Piemonte, Italy.
⁵ Division of Gynecology Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Piedmont, Italy alebuda1972@gmail.com.

PMID: 38011989
DOI: 10.1136/ijgc-2023-004863

Abstract

Objective: The objective of this systematic review was to evaluate the effect of different types of neoadjuvant chemotherapy regimens, in terms of optimal pathological response and oncological outcomes, in patients with locally advanced cervical cancer.

Methods: A systematic search of the literature was performed. MEDLINE through PubMed and Embase databases were searched from inception to June 2023. The study was registered in PROSPERO (ID number CRD42023389806). All women with a pathological diagnosis of locally advanced cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009 classification stages IB2-IVA), any age or histology, who underwent intravenous neoadjuvant chemotherapy before radical surgery, and articles only in English language, were included. We conducted a meta-analysis for optimal pathological response after surgery and survival outcomes. The risk of bias was assessed using the Newcastle-Ottawa scale and the Risk of Bias 2 (RoB) tools. The review methods and results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: 25 studies with a total number of 1984 patients fulfilled the eligibility criteria of our review and were included for data extraction and efficacy analysis. When compared with a two-drug regimen, the three-drug combination including cisplatin, paclitaxel, and ifosfamide or anthracyclines showed superior efficacy in terms of optimal pathological response with an odds ratio of 0.38 (95% CI 0.24 to 0.61, p<0.0001), with no difference in disease-free survival (hazard ratio (HR) 0.72, 95% CI 0.50 to 1.03, I²=0%, p=0.07) and higher overall survival (HR 0.63, 95% CI 0.41 to 0.97, I²=0%, p=0.03).

Conclusions: The three-drug combination of cisplatin, paclitaxel, and ifosfamide or anthracyclines showed a higher rate of complete or optimal partial response, with the triple regimens having an advantage over the platinum-based schedules in terms of overall survival. Neoadjuvant chemotherapy followed by radical surgery should not be considered a standard of care in locally advanced cervical cancer.

Keywords: Cervical Cancer; Gynecologic Surgical Procedures; Hysterectomy.