Emerging Evidence on Induction Chemotherapy and Implications for Care of Cervical Cancer Patients in Low Resource Settings

PURPOSE Induction chemotherapy followed by chemoradiation was found to further improve both overall survival (OS) and progression free survival (PFS) for locally advance cervical cancer in a phase 3 INTERLACE trial. This is a significant improvement in the care of cervical cancer since the 1999 clinical announcement of chemoradiation as the standard of care by National Institute of Health (NIH). We hereby propose exploration of the application of the study to improve cervical cancer care in low resource settings. METHODS We constructed a typical clinical course for a cervical cancer patient in low resource settings based on interactions with our patients needing radiotherapy services. We then conducted a desktop review of literature to broaden our understanding of interventions employed by other healthcare providers in low resource settings to provide care for cervical cancer patients needing radiotherapy services. Those interventions involving use of chemotherapy were further explored in the light of the findings of the INTERLACE trials for possible extrapolation of evidence. RESULTS The challenges of access to radiotherapy services in low resource settings is multifactorial including availability, affordability, accessibility, acceptability and sustainability factors. There are robust multinational collaborative efforts to address the availability factors with little or no considerations for the other factors. Chemotherapy similar to the protocol used in the INTERLACE trial has been innovatively used in various settings to provide some care for cervical cancer patients needing but not able to receive radiotherapy services due to various factors. There is however no documented evidence on impact of such innovations on the burden of cervical cancer in settings where they are applied. CONCLUSION The INTERLACE trial has opened a new frontier on the role of chemotherapy in the management of locally advanced cervical cancer that can be further explored to improve the outcome of care in resource constraints settings with limited access to radiotherapy services.