Randomized Phase III Study Comparing Neoadjuvant Chemotherapy Followed by Surgery Versus Chemoradiation in Stage IB2-IIB Cervical Cancer: EORTC-55994

• Published in: Journal of clinical oncology Vol. 41; no. 32; pp. 5035 - 5043
• Main Authors: Kenter, Gemma G., Greggi, Stefano, Vergote, Ignace, Katsaros, Dionyssios, Kobierski, Juliusz, van Doorn, Heleen, Landoni, Fabio, van der Velden, Jacobus, Reed, Nicholas, Coens, Corneel, van Luijk, Iske, Colombo, Nicoletta, Steen-Banasik, Elzbietta van der, Ottevanger, Nelleke, Casado, Antonio, Schratter-Sehn, Annemarie, Vermorken, Jan Baptist, Altintas, Sevilay, Kridelka, Frederic, Goffin, Frédéric, Joly-Lobbedez, Florence, Zola, Paolo, Ferrero, Annamaria, Franchi, Massimo, Donadello, Nicoletta, Massuger, Leon, Ansink, Anca, Van Doorn, Helena, Van Der Velden, Jacobus, Verheijen, Rene, van Baal, W.M., Kenter, Gemma, Van Dorst, Eleonora, Gaarenstroom, Katja, Kristensen, Gunnar, Kobierska, Anna, Kobierski, Julisz, de Oliveira, Carlos Freire, Frutuoso, Cristina, Casado Herraez, Antonio, Jyothirmayi, Rema, Nordin, Andrew, Rustin, Gordon
• Format: Journal Article
• Language: English
• Published: 10.11.2023
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.22.02852

The EORTC-55994 trial compared neoadjuvant chemotherapy (NACT) followed by radical surgery with concomitant chemoradiation (CCRT) in patients with Stage IB2-IIB cervical cancer. This trial took almost 12 years to recruit 626 patients with a median follow-up of 8.7 years. PURPOSE This multicenter trial by the European Organisation for Research and Treatment of Cancer Gynecological Cancer Group was motivated by conflicting evidence on the value of neoadjuvant chemotherapy before surgery compared with concomitant chemoradiotherapy (CCRT) in stage IB2-IIB cervical carcinoma. METHODS Between May 2002 and January 2014, 626 patients with International Federation of Gynecology and Obstetrics stage IB2-IIb were randomly assigned between neoadjuvant chemotherapy followed by surgery (NACT-S; n = 314) and standard CCRT (n = 312). The primary end point was 5-year overall survival (OS) rate. Secondary end points were progression-free survival, OS, toxicity, and health-related quality of life (HRQOL). RESULTS After a median follow-up of 8.7 years, 198 patients (31.6%) died. Age, stage, and cell type were balanced in both arms. Protocol treatment was completed in 223 of 314 (71%) patients in NACT-S and 257 of 312(82%) in CCRT arms. Main reasons for incomplete protocol treatment were toxicity (30 of 314; 9.6%) and progressive disease (21 of 314; 6.7%) in the NACT-S arm and toxicity (23 of 312; 7.4%) and patient refusal (13 of 312; 4.2%) in the CCRT arm. Additional radiotherapy after completed NACT-S was given to 107 patients (48%), and additional surgery to 20 patients (8%) after completed CCRT. Short-term adverse events (AEs) ≥grade 3 occurred more frequently with NACT-S (41% v 23%), and long-term AEs ≥grade 3 more often with CCRT (21% v 15%). The 5-year OS was not significantly different between NACT-S (72%; 95% CI, 66 to 77) and CCRT (76%; 95% CI, 70 to 80). CONCLUSION This trial failed to demonstrate superiority in favor of the NACT-S arm but resulted in acceptable morbidity and HRQOL in both arms.