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Long-Term Disease Control with Triapine-Based Radiochemotherapy for Patients with Stage IB2-IIIB Cervical Cancer.

Kunos CA, Sherertz TM - Front Oncol (2014)

Bottom Line: The Kaplan-Meier method estimated survivals.A median 3.4 years of follow-up time (range, 0.3-7.6 years) has been observed.The 3-year pelvic locoregional relapse rate, disease-free survival, and overall survival were 4% [95% confidence interval (CI), 0-20%], 80% (95% CI: 71-89%), and 82% (95% CI: 74-90%), respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Summa Cancer Institute, Summa Health System , Akron, OH , USA.

ABSTRACT

Background: National Cancer Institute phase I #7336 and phase II #8327 clinical trials explored the safety and efficacy of triapine (NSC #663249) added to cisplatin radiochemotherapy in untreated patients with advanced-stage cervical cancer. Triapine inhibits ribonucleotide reductase, the rate-limiting enzyme responsible for DNA-building deoxyribonucleotides, and thereby, enhances radiochemosensitivity by prolonging DNA repair time. Here, we report 3-year efficacy endpoints of pelvic locoregional relapse rate, disease-free, and overall survivals.

Methods: Eligible patients with bulky IB-IIIB cervical cancer underwent three-times weekly triapine (25 or 50 mg/m(2)), once-weekly cisplatin (40 mg/m(2)), and conventional daily pelvic radiation followed by brachytherapy. A cumulative incidence method estimated pelvic locoregional relapse rates. Disease-free survival was measured from radiochemotherapy start date to the date of first relapse or cancer-related death. Overall survival was measured from radiochemotherapy start date to the date of any-cause death. The Kaplan-Meier method estimated survivals.

Findings: Between 2006 and 2011, 24 untreated patients with cervical cancer met criteria for reporting in this study. A median 3.4 years of follow-up time (range, 0.3-7.6 years) has been observed. All had squamous cancers and the majority had either node-positive stage IB-IIA (33%) or stage IIIB (42%) disease. The 3-year pelvic locoregional relapse rate, disease-free survival, and overall survival were 4% [95% confidence interval (CI), 0-20%], 80% (95% CI: 71-89%), and 82% (95% CI: 74-90%), respectively.

Interpretation: Triapine radiochemotherapy was safe, active, and effective in patients with untreated advanced-stage cervical cancer, worthy of randomized clinical trial study.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier survival curves for disease-free survival (A) and overall survival (B).
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Figure 2: Kaplan–Meier survival curves for disease-free survival (A) and overall survival (B).

Mentions: The 3-year pelvic locoregional relapse rate, disease-free survival, and overall survival were 4% (95% CI: 0–20%), 80% (95% CI: 71–89%), and 82% (95% CI: 74–90%), respectively. Figure 2 plots disease-free survival and overall survival curves. Nineteen (79%) patients were without treatment failure at the time of last follow-up. Among women in this particular cohort, a single right pelvic sidewall relapse was detected at 8 months after the start of triapine radiochemotherapy. In this patient, a 3-month FDG PET/CT suggested an incomplete pelvic lymph node metabolic response (2). At surgery conducted to palliate non-treatment-related pain, a site of viable extranodal disease was removed surgically from the right pelvic sidewall. Four extrapelvic relapses (i.e., outside the radiation portal) have been recorded: two (8%) para-aortic lymph node relapses; one (4%) abdominal wall relapse; and one (4%) left supraclavicular lymph node relapse. Five (20%) deaths have occurred. Two (8%) of the deaths were attributed to cancer-related factors.


Long-Term Disease Control with Triapine-Based Radiochemotherapy for Patients with Stage IB2-IIIB Cervical Cancer.

Kunos CA, Sherertz TM - Front Oncol (2014)

Kaplan–Meier survival curves for disease-free survival (A) and overall survival (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4109518&req=5

Figure 2: Kaplan–Meier survival curves for disease-free survival (A) and overall survival (B).
Mentions: The 3-year pelvic locoregional relapse rate, disease-free survival, and overall survival were 4% (95% CI: 0–20%), 80% (95% CI: 71–89%), and 82% (95% CI: 74–90%), respectively. Figure 2 plots disease-free survival and overall survival curves. Nineteen (79%) patients were without treatment failure at the time of last follow-up. Among women in this particular cohort, a single right pelvic sidewall relapse was detected at 8 months after the start of triapine radiochemotherapy. In this patient, a 3-month FDG PET/CT suggested an incomplete pelvic lymph node metabolic response (2). At surgery conducted to palliate non-treatment-related pain, a site of viable extranodal disease was removed surgically from the right pelvic sidewall. Four extrapelvic relapses (i.e., outside the radiation portal) have been recorded: two (8%) para-aortic lymph node relapses; one (4%) abdominal wall relapse; and one (4%) left supraclavicular lymph node relapse. Five (20%) deaths have occurred. Two (8%) of the deaths were attributed to cancer-related factors.

Bottom Line: The Kaplan-Meier method estimated survivals.A median 3.4 years of follow-up time (range, 0.3-7.6 years) has been observed.The 3-year pelvic locoregional relapse rate, disease-free survival, and overall survival were 4% [95% confidence interval (CI), 0-20%], 80% (95% CI: 71-89%), and 82% (95% CI: 74-90%), respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Summa Cancer Institute, Summa Health System , Akron, OH , USA.

ABSTRACT

Background: National Cancer Institute phase I #7336 and phase II #8327 clinical trials explored the safety and efficacy of triapine (NSC #663249) added to cisplatin radiochemotherapy in untreated patients with advanced-stage cervical cancer. Triapine inhibits ribonucleotide reductase, the rate-limiting enzyme responsible for DNA-building deoxyribonucleotides, and thereby, enhances radiochemosensitivity by prolonging DNA repair time. Here, we report 3-year efficacy endpoints of pelvic locoregional relapse rate, disease-free, and overall survivals.

Methods: Eligible patients with bulky IB-IIIB cervical cancer underwent three-times weekly triapine (25 or 50 mg/m(2)), once-weekly cisplatin (40 mg/m(2)), and conventional daily pelvic radiation followed by brachytherapy. A cumulative incidence method estimated pelvic locoregional relapse rates. Disease-free survival was measured from radiochemotherapy start date to the date of first relapse or cancer-related death. Overall survival was measured from radiochemotherapy start date to the date of any-cause death. The Kaplan-Meier method estimated survivals.

Findings: Between 2006 and 2011, 24 untreated patients with cervical cancer met criteria for reporting in this study. A median 3.4 years of follow-up time (range, 0.3-7.6 years) has been observed. All had squamous cancers and the majority had either node-positive stage IB-IIA (33%) or stage IIIB (42%) disease. The 3-year pelvic locoregional relapse rate, disease-free survival, and overall survival were 4% [95% confidence interval (CI), 0-20%], 80% (95% CI: 71-89%), and 82% (95% CI: 74-90%), respectively.

Interpretation: Triapine radiochemotherapy was safe, active, and effective in patients with untreated advanced-stage cervical cancer, worthy of randomized clinical trial study.

No MeSH data available.


Related in: MedlinePlus