Effectiveness and Safety Profile of Cisplatin Versus Nab-Paclitaxel Concomitant Chemoradiotherapy in Postoperative Early-Stage Cancer of Cervix

Aalia  Bashir; Muhammad Junaid  Hassan; Anam  Siddque

doi:10.54112/bcsrj.v6i4.1673

Authors

Aalia Bashir Department of Radiotherapy, Allama Iqbal Teaching Hospital DG Khan, Pakistan
Muhammad Junaid Hassan Department of Radiotherapy, Nishtar Medical University and Hospital Multan, Pakistan
Anam Siddque Department of Radiation Oncology, Cancer Care Hospital and Research Centre Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i4.1673

Keywords:

Carcinoma, Cancer, Chemotherapy, Radiotherapy

Abstract

Cervical cancer is a prevalent gynecologic malignancy with significant morbidity and mortality. Concomitant chemoradiotherapy remains the cornerstone of treatment for locally advanced stages. Cisplatin is the standard radiosensitizer, but alternative agents such as nab-paclitaxel may offer comparable efficacy with fewer side effects. Objective: To compare the effectiveness and safety profile of concomitant cisplatin versus nab-paclitaxel chemotherapy in patients with locally advanced cervical cancer. Methods: A retrospective study was conducted at the Oncology Department, Nishtar Hospital, Multan, from March 2023 to March 2025. A total of 100 women with stage I or II cervical cancer who had undergone radical pelvic surgery were included. All patients received adjuvant chemoradiotherapy 4–6 weeks postoperatively. External beam radiotherapy was administered at doses of 45–58.8 Gy over 5–5.6 weeks (1.8–2.1 Gy per fraction, five days per week). Patients were divided into two groups: Group A (n=50): Received cisplatin (40 mg/m² IV weekly). Group B (n=50): Received nab-paclitaxel (100 mg IV weekly). Overall survival (OS), progression-free survival (PFS), and treatment-related adverse effects were assessed. Statistical analysis was performed using hazard ratios (HR) with 95% confidence intervals (CI) and p-values, with significance set at <0.05. Results: Both treatment groups demonstrated comparable outcomes in terms of OS (HR: 0.89; 95% CI: 0.061–14.10; p=0.85) and PFS (HR: 0.98; 95% CI: 0.11–15.53; p=1.0). The 2-year OS was 98% in the cisplatin group and 97% in the nab-paclitaxel group. PFS at 2 years was 98% for both groups. Hematological toxicity and gastrointestinal side effects were significantly higher in the cisplatin group (p<0.05), whereas alopecia was more prevalent in the nab-paclitaxel group. No treatment-related mortality was observed. Conclusion: Nab-paclitaxel combined with radiotherapy is a viable and effective alternative to cisplatin in the management of early-stage cervical cancer. It offers comparable survival outcomes with a more favorable safety profile, particularly concerning hematologic and gastrointestinal toxicity.

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References

Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. The Lancet Global Health. 2020;8(2):e191-e203.

Cao L, Wen H, Feng Z, Han X, Zhu J, Wu X. Role of adjuvant therapy after radical hysterectomy in intermediate-risk, early-stage cervical cancer. International Journal of Gynecological Cancer. 2021;31(1):52-58.

Wu X, Sun Y, Yang H, Wang J, Lou H, Li D, et al. Cadonilimab plus platinum-based chemotherapy with or without bevacizumab as first-line treatment for persistent, recurrent, or metastatic cervical cancer (COMPASSION-16): a randomised, double-blind, placebo-controlled phase 3 trial in China. The Lancet. 2024;404(10463):1668-1676.

Nguyen VT, Winterman S, Playe M, Benbara A, Zelek L, Pamoukdjian F, et al. Dose-intense cisplatin-based neoadjuvant chemotherapy increases survival in advanced cervical cancer: an up-to-date meta-analysis. Cancers. 2022;14(3):842.

Rodriguez J, Viveros-Carreño D, Pareja R. Adjuvant treatment after radical surgery for cervical cancer with intermediate risk factors: is it time for an update? International Journal of Gynecological Cancer. 2022;32(10):1219-1226.

Colombo N, Van Gorp T, Matulonis UA, Oaknin A, Grisham RN, Fleming GF, et al. Relacorilant+ nab-paclitaxel in patients with recurrent, platinum-resistant ovarian cancer: a three-arm, randomized, controlled, open-label phase II study. Journal of Clinical Oncology. 2023;41(30):4779-4789.

Li-ying H, Yan L, Peng L, Shu S, Pei-ling L. Research progress of nanoparticle albumin bound paclitaxel in neoadjuvant chemotherapy for cervical cancer. Journal of International Obstetrics and Gynecology. 2021;48(2):135.

Koay EJ, Zaid M, Aliru M, Bagereka P, Van Wieren A, Rodriguez MJ, et al. Nab-paclitaxel, capecitabine, and radiation therapy after induction chemotherapy in treating patients with locally advanced and borderline resectable pancreatic cancer: phase 1 trial and imaging-based biomarker validation. International Journal of Radiation Oncology* Biology* Physics. 2022;114(3):444-453.

Oppelt P, Ley J, Daly M, Rich J, Paniello R, Jackson RS, et al. nab-Paclitaxel and cisplatin followed by cisplatin and radiation (Arm 1) and nab-paclitaxel followed by cetuximab and radiation (Arm 2) for locally advanced head and neck squamous-cell carcinoma: a multicenter, non-randomized phase 2 trial. Medical Oncology. 2021;38:1-11.

Zhao N, Li Y, Chen X, Ma J, Luo W, Li Y. Evaluating the clinical efficacy and safety of concurrent chemoradiotherapy with cisplatin and nab-paclitaxel in postoperative early-stage cervical cancer. Journal of Cancer Research and Clinical Oncology. 2024;150(5):233.

Yu X-L, Wu M-F, Ding L, Yang J, Bai S-M. Enhanced efficacy of neoadjuvant chemotherapy with nab-paclitaxel and platinum for locally advanced cervical cancer. Cancer Management and Research. 2021:9297-9304.

Han J, Zakeri K, Raab G, Hesse J, Shamseddine A, Chen L, et al. Concurrent carboplatin and paclitaxel definitive radiation therapy for locally advanced head and neck cancer. Head & neck. 2023;45(9):2207-2216.

Jiang P, Deng X, Qu A, Jiang W, Guo F, Han Q, et al. Image guidance volume-modulated arc radiation therapy concurrently with nab-paclitaxel plus cisplatin for patients with locally advanced cervical cancer: a single-arm dose escalation trial. International Journal of Radiation Oncology* Biology* Physics. 2023;115(5):1197-1204.

Li J-j, Wang J-h, Dingv Y, Li D-d, Wen X-z, Zhao J-j, et al. Efficacy and safety of anti-PD-1 inhibitor combined with nab-paclitaxel in Chinese patients with refractory melanoma. Journal of Cancer Research and Clinical Oncology. 2021:1-11.

Sugawara S, Lee J-S, Kang J-H, Kim H, Inui N, Hida T, et al. Nivolumab with carboplatin, paclitaxel, and bevacizumab for first-line treatment of advanced nonsquamous non-small-cell lung cancer. Annals of Oncology. 2021;32(9):1137-1147.

Wang A, Zhang F, Zhang X. Study on the intake and efficacy of nab-paclitaxel in patients with advanced cervical cancer. European Journal of Gynaecological Oncology. 2023;44(4).