Cervical clearance: early HPV clearance tied to improved survival

  • Srivastava AJ & al.
  • Cancer
  • 8 Jul 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Early clearance of HPV after definitive chemoradiation is associated with improved survival in patients with cervical cancer.

Why this matters

  • 6-week follow-up may represent a critical point at which decisions could be made regarding treatment escalation.

Study design

  • Study of 97 patients with invasive cervical cancer, treated with definitive intent chemoradiation.
  • Funding: None disclosed.

Key results

  • The mean follow-up time was 25 months.
  • 74.2% of patients had early clearance.
  • Patients with early clearance (vs persistent expression) were more likely to be infected with HPV-16 (77.8%; P<.01>
  • At 2 years, pelvic control (76.9% vs 50.2%; P=.01) and OS (80.9% vs 52.2%; P<.01 were significantly higher in patients with early clearance vs those persistent expression.>
  • In patients with complete metabolic response, early clearance vs persistent expression was associated with better:
    • Pelvic control: 92.9% vs 61.1% (P=.04).
    • Distant control: 94.7% vs 73.3% (P=.02).
    • PFS: 90.5% vs 54.7% (P<.01>
    • OS: 95.6% vs 66.7% (P=.04).
  • HPV clearance within 6 weeks was associated with lower risk for pelvic failure (HR, 0.38; P=.01), distant failure (HR, 0.24; P<.01 and mortality p=".01).</li">
  • Significant independent predictors of mortality:
    • Early clearance of HPV: HR, 0.46 (P=.04).
    • Less than a complete response on posttreatment PET imaging: HR, 5.52 (P<.01>

Limitations

  • Single-center study.