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Gynecologic Oncology

Capecitabine-Based Chemoradiotherapy with Adjuvant Capecitabine for Locally Advanced Squamous Carcinoma of the Uterine Cervix: Phase II Results

^aPhilippine General Hospital-University of the Philippines, Manila, Philippines; ^bMaharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand; ^cJose R Reyes Memorial Medical Center, Manila, Philippines; ^dMakati Medical Center, Makati, Philippines; ^eKing Chulalongkorn Memorial Hospital, Bangkok, Thailand; ^fRoche Products, Dee Why, Australia

Key Words. Chemoradiation • Capecitabine • Cervical cancer • Adjuvant • Radiosensitizer • Oral fluoropyrimidine

Correspondence: Efren J. Domingo, M.D., Ph.D., Department of Obstetrics-Gynecology, Philippine General Hospital, University of the Philippines, Taft Avenue, Manila, Philippines. Telephone: 632-526-0868; Fax: 632-526-0868; e-mail: efrendomingo{at}hotmail.com

Received March 6, 2009; accepted for publication June 23, 2009; first published online in THE ONCOLOGIST Express on August 6, 2009.

Disclosures: Efren Domingo: None; Vicharn Lorvidhaya: None; Rey de los Reyes: None; Teresa SyOrtin: None; Pimkhuan Kamnerdsupaphon: None; Chawalit Lertbutsayanukul: None; Erwin Vito-Cruz: None; Ekkasit Tharavichitkul: None; Kate Jin: Employment/leadership position: Roche Products, Australia; Motoko Yoshihara: Employment/leadership position: Roche Products, Australia; Ownership interest: Roche; Nonette Cupino: None; Prasert Lertsanguansinchai: None.

The article discusses an unlabeled, investigational, or alternative use of capecitabine (Xeloda®, Hoffmann-La Roche Inc.) to treat cervical cancer.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the independent peer reviewers.

Objectives. Cisplatin-based chemoradiotherapy is the standard treatment for locally advanced cervical cancer but causes considerable toxicity. Capecitabine and radiotherapy show preclinical synergy and clinical activity. The activity, tolerability, and oral administration of capecitabine make it an attractive adjunctive therapy.

Methods. In this phase II study, patients with untreated International Federation of Gynecology and Obstetrics stage IIB–IIIB cervical cancer received capecitabine, 825 mg/m² twice daily (Monday–Friday), during radiation (45 Gy per 25 fractions external-beam radiotherapy and 26 Gy high-dose rate brachytherapy to point A, maximum 8 weeks), followed by six cycles of capecitabine, 1,000 mg/m² twice daily (days 1–14 every 21 days).

Results. The overall response rate in 60 patients was 88% (95% confidence interval [CI], 77.4%–95.2%), including complete responses (CRs) in 80% of patients. The 1-year progression-free and overall survival rates were 86% (95% CI, 77%–95%) and 95% (95% CI, 89%–100%), respectively. At 23 months, 76% of patients were progression free (95% CI, 65%–88%) and CR was maintained in 90% (95% CI, 81%–99%) of the 48 patients achieving a CR. There were three grade 3 or 4 treatment-related events: reversible grade 4 hypokalemia, grade 3 diarrhea, and grade 3 hand–foot syndrome.

Conclusions. Capecitabine-based chemoradiotherapy with adjuvant capecitabine is a well-tolerated option with an early signal of efficacy meriting further evaluation.