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Fracasso PM, Duska LR, Thaker PH, Gao F, Zoberi I, Dehdashti F, Siegel BA, Uliel L, Menias CO, Rehm PK, Goodner SA, Creekmore AN, Lothamer HL, Rader JS. An Exploratory Study of Neoadjuvant Cetuximab Followed by Cetuximab and Chemoradiotherapy in Women With Newly Diagnosed Locally Advanced Cervical Cancer. Am J Clin Oncol 2022; 45:286-293. [PMID: 35696702 PMCID: PMC9233135 DOI: 10.1097/coc.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study explored the feasibility of cetuximab with chemoradiation in women with cervical carcinoma and evaluated fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) to assess early response to cetuximab (NCT00292955). PATIENTS AND METHODS Eligible patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB-IVB invasive carcinoma of the uterine cervix were treated on 1 of 3 dose levels (DL). DL1 consisted of neoadjuvant cetuximab, then concurrent radiotherapy with cetuximab 250 mg/m2/cisplatin 40 mg/m2, followed by weekly cetuximab. DL2 consisted of radiotherapy with cetuximab 200 mg/m2 and cisplatin 30 mg/m2. DL3 consisted of radiotherapy with cetuximab 250 mg/m2 and cisplatin 30 mg/m2. Patients underwent 18F-FDG-PET/CT before treatment, after neoadjuvant cetuximab, and at the end of treatment. RESULTS Of the 21 patients enrolled, 9, 3, and 9 were treated in DL1, DL2, and DL3, respectively. DL1 required dose reductions due to gastrointestinal toxicities. DL2 and 3 were tolerated with 1 dose-limiting toxicity (grade 4 renal failure) at DL3. Following 3 weekly treatments of neoadjuvant cetuximab in DL1, 7 patients had maximum standardized uptake value changes on 18F-FDG-PET/CT consistent with response to cetuximab. Of the 12 patients with locally advanced disease, eleven evaluable patients had no evidence of disease on 18F-FDG-PET/CT at treatment end. Five-year progression-free survival and overall survival rates for all patients were 57.5% and 58.5%, respectively. CONCLUSIONS Cetuximab with cisplatin 30 mg/m2 and radiotherapy was tolerated. 18F-FDG-PET/CT demonstrated early evidence of response to neoadjuvant cetuximab. With advances in precision oncology and the recent approval of pembrolizumab in metastatic cervical cancer, dual-target inhibition with an epidermal growth factor receptor inhibitor may be a promising treatment in the future.
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Affiliation(s)
- Paula M. Fracasso
- UVA Cancer Center, University of Virginia, Charlottesville,
VA, 22908
- Department of Medicine, University of Virginia,
Charlottesville, VA 22908
| | - Linda R. Duska
- UVA Cancer Center, University of Virginia, Charlottesville,
VA, 22908
- Department of Obstetrics and Gynecology, University of
Virginia, Charlottesville, VA 22908
| | - Premal H. Thaker
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Obstetrics and Gynecology, Washington
University School of Medicine, St. Louis, MO, 63110
| | - Feng Gao
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Surgery and the Division of Public Health
Sciences, Washington University School of Medicine, St. Louis, MO, 63110
| | - Imran Zoberi
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Radiation Oncology, Washington University
School of Medicine, St. Louis, MO, 63110
| | - Farrokh Dehdashti
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Division of Nuclear Medicine, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Barry A. Siegel
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Division of Nuclear Medicine, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Livnat Uliel
- Division of Nuclear Medicine, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Christine O. Menias
- Division of Diagnostic Radiology, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Patrice K. Rehm
- Division of Nuclear Medicine, University of Virginia,
Charlottesville, VA 22908
| | - Sherry A. Goodner
- UVA Cancer Center, University of Virginia, Charlottesville,
VA, 22908
| | - Allison N. Creekmore
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
| | - Heather L. Lothamer
- Department of Obstetrics and Gynecology, University of
Virginia, Charlottesville, VA 22908
| | - Janet S. Rader
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Obstetrics and Gynecology, Washington
University School of Medicine, St. Louis, MO, 63110
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