Platinum sensitivity and non-cross-resistance of cisplatin analogue with cisplatin in recurrent cervical cancer

Abstract

Objective: The concept of platinum sensitivity and cross-resistance among platinum agents are widely known in the management of recurrent ovarian cancer. The aim of this study was to evaluate two hypotheses regarding the validity of the concept of platinum sensitivity and non-cross-resistance of cisplatin analogue with cisplatin in recurrent cervical cancer.

Methods: In this retrospective study, the clinical data of patients with recurrent cervical cancer, who had a history of receiving cisplatin based chemotherapy (including concurrent chemoradiotherapy [CCRT] with cisplatin) and who received second-line chemotherapy at the time of recurrence between April 2004 and July 2012 were reviewed.

Results: In total, 49 patients--34 squamous cell carcinomas (69.4%) and 15 non-squamous cell carcinomas (30.6%)--were enrolled. The median age was 53 years (range, 26 to 79 years). Univariate and multivariate analysis showed that a platinum free interval (PFI) of 12 months has a strong relationship with the response rate to second-line chemotherapy. Upon multivariate analysis of survival after second-line platinum-based chemotherapy, a PFI of 12 months significantly influenced both progression-free survival (hazard ratio [HR], 0.349; 95% confidence interval [CI], 0.140 to 0.871; p=0.024) and overall survival (HR, 0.322; 95% CI, 0.123 to 0.842; p=0.021). In patients with a PFI of less than 6 months, the difference of progression-free survival between patients with re-administration of cisplatin (3.0 months) and administration of cisplatin analogue (7.2 months) as second-line chemotherapy was statistically significant (p=0.049, log-rank test).

Conclusion: The concept of platinum sensitivity could be applied to recurrent cervical cancer and there is a possibility of noncross-resistance of cisplatin analogue with cisplatin.

Keywords: Cisplatin; Disease-Free Survival; Neoplasm Recurrence, Local; Platinum; Uterine Cervical Neoplasms.

Fig. 1. Kaplan-Meier curves of overall survival (OS): a platinum free interval (PFI) more than 12 mo vs. less than 12 mo. The median OS: 27.0 mo vs. 12.6 mo, respectively (log-rank test).

Fig. 2. Kaplan-Meier curves of platinum free interval (PFI) of a PFI of less than 6 mo: administration of cisplatin (CDDP) analogue vs. readministration of CDDP. (A) The median progression-free survival (PFS) of a PFI of less than 6 mo: 7.2 mo vs. 3.0 mo, respectively (log-rank test). (B) The median PFS of a PFI of less than 12 mo: 5.1 mo vs. 3.7 mo, respectively (log-rank test).