Neoadjuvant Chemotherapy with Weekly Cisplatin and Paclitaxel Followed by Chemoradiation for Locally Advanced Cervical Cancer

e-ISSN: 0976-822X, p-ISSN:2961-6042 Available online on http://www.ijcpr.com/ International Journal of Current Pharmaceutical Review and Research 2025; 17(8); 781-786 Paul et al. International Journal of Current Pharmaceutical Review and Research 781 Original Research Article Neoadjuvant Chemotherapy with Weekly Cisplatin and Paclitaxel Followed by Chemoradiation for Locally Advanced Cervical Cancer Sourav Paul1, Juhi2 1Senior Resident, MBBS, MD (Radiation Oncology), Department of Radiotherapy, R G Kar Medical College & Hospital, Kolkata, West Bengal 700004 2Junior Resident, MBBS, MD PGT, Department of Radiotherapy, R G Kar Medical College & Hospital, Kolkata, West Bengal 700004 Received: 01-06-2025 / Revised: 16-07-2025 / Accepted: 13-08-2025 Corresponding Author: Dr. Sourav Paul Conflict of interest: Nil Abstract Introduction: Locally advanced cervical cancer (LACC) remains a significant therapeutic challenge, with standard treatment involving concurrent chemoradiation. Neoadjuvant chemotherapy (NACT) before chemoradiation may improve tumor shrinkage, facilitate better local control, and reduce distant metastasis. This study evaluates the efficacy and safety of weekly cisplatin and paclitaxel as neoadjuvant chemotherapy followed by chemoradiation in patients with LACC. Methods: This prospective observational study was conducted over a period of one year at R G Kar Medical College. A total of 80 patients with histologically confirmed locally advanced cervical cancer (FIGO stages IB2 to IIIB) were enrolled. Key study variables included patient age, FIGO stage, tumor histology, and Eastern Cooperative Oncology Group (ECOG) performance status. Patients received neoadjuvant chemotherapy with weekly cisplatin and paclitaxel followed by chemoradiation. Treatment response was assessed using clinical and radiological parameters, while toxicity was monitored and graded according to standard criteria. Outcomes measured included tumor response, toxicity profile, progression-free survival, and overall survival. Results: The study included 80 patients with locally advanced cervical cancer, predominantly FIGO stage IIB and squamous cell carcinoma. Following neoadjuvant chemotherapy with weekly cisplatin and paclitaxel, 85% of patients achieved an overall response (30% complete, 55% partial). Tumor size significantly decreased from 5.4 cm to 3.2 cm (p < 0.001). The treatment was well tolerated, with manageable hematological and nonhematological toxicities. At 12 months follow-up, progression-free survival was 72.5%, and overall survival was 85%. Patients with complete or partial response had significantly better survival outcomes than those with stable or progressive disease (PFS: 14 vs. 8 months, p = 0.002; OS: 18 vs. 11 months, p = 0.004). Conclusions: Weekly cisplatin and paclitaxel as neoadjuvant chemotherapy followed by standard chemoradiation is feasible and well tolerated in LACC patients, with encouraging early clinical response and survival outcomes. Further randomized controlled trials are warranted to confirm the benefit of this sequential approach compared to chemoradiation alone. Keywords: Locally Advanced Cervical Cancer, Neoadjuvant Chemotherapy, Cisplatin, Paclitaxel, Chemoradiation, Clinical Response, Toxicity. This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) and the Budapest Open Access Initiative (http://www.budapestopenaccessinitiative.org/read), which permit unrestricted use, distribution, and reproduction in any medium, provided original work is properly credited. Introduction Cervical cancer remains one of the leading causes of cancer-related morbidity and mortality among women worldwide, particularly in lowand middleincome countries. According to the World Health Organization, approximately 600,000 new cases of cervical cancer are diagnosed annually, with a majority presenting as locally advanced cervical cancer (LACC) at the time of diagnosis [1]. LACC, defined as International Federation of Gynecology and Obstetrics (FIGO) stage IB2 to IIIB, is characterized by bulky tumors confined to the cervix and adjacent tissues without distant metastasis. The management of LACC poses significant challenges due to the high risk of local recurrence and distant failure despite treatment [2]. The current standard of care for LACC is concurrent chemoradiation therapy (CCRT), which combines external beam radiation therapy (EBRT), intracavitary brachytherapy, and weekly cisplatin chemotherapy [3]. Cisplatin acts as a radiosensitizer, enhancing the efficacy of radiation therapy by inhibiting DNA repair in tumor cells. This combined modality approach has improved locoregional control and survival rates compared to radiation alone. However, treatment failure still occurs in approximately 30–40% of patients due to persistent disease or distant metastases [4]. International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Paul et al. International Journal of Current Pharmaceutical Review and Research 782 In an effort to improve outcomes, neoadjuvant chemotherapy (NACT) administered before chemoradiation has been explored. The rationale for NACT is to reduce tumor bulk, eradicate micrometastatic disease, and improve the tumor microenvironment for subsequent radiation [5]. Early trials with NACT demonstrated mixed results, but recent advances in chemotherapy regimens and supportive care have renewed interest in this approach [6]. Among the chemotherapy agents, cisplatin and paclitaxel have shown synergistic cytotoxicity and radiosensitization effects, making them a preferred combination in cervical cancer [7]. Paclitaxel, a microtubule-stabilizing agent, disrupts mitotic spindle formation leading to apoptosis, and has been effectively combined with cisplatin in various solid tumors. Weekly dosing schedules of cisplatin and paclitaxel are considered to balance efficacy with manageable toxicity and maintain dose intensity [8]. This regimen is hypothesized to enhance tumor response prior to radiation, potentially improving long-term control and survival. Several recent studies have evaluated the efficacy of NACT with weekly cisplatin and paclitaxel followed by chemoradiation in patients with LACC. Results have suggested improved tumor response rates, decreased tumor size, and favorable toxicity profiles [9]. Moreover, this sequential strategy may allow for better patient selection and individualized treatment planning based on early chemotherapy response. However, evidence remains limited, and optimal dosing, duration, and timing in relation to chemoradiation require further elucidation. Despite promising preliminary data, the integration of NACT with weekly cisplatin and paclitaxel followed by standard chemoradiation is not yet universally accepted as standard treatment. Challenges include potential increased toxicity, risk of delaying definitive radiation, and lack of large randomized controlled trials demonstrating survival benefit. Nonetheless, ongoing clinical trials and institutional experiences have generated valuable data supporting the feasibility and potential benefit of this approach [10]. In summary, locally advanced cervical cancer continues to represent a therapeutic challenge despite advances in chemoradiation. Neoadjuvant chemotherapy with weekly cisplatin and paclitaxel prior to chemoradiation is an emerging strategy aimed at improving tumor response and survival outcomes. Continued research is critical to define the optimal treatment protocols and establish this approach in routine clinical practice. Materials and Methods Study Design: Prospective observational study. Place of study: R G Kar Medical College. Period of study: 1 Year. Study Variables • Age • FIGO Stage • Histology • ECOG Performance Status • Response Category • Parameter • Toxicity • Outcome Sample Size: 80 Patients with histologically confirmed locally advanced cervical cancer (FIGO stages IB2 to IIIB). Inclusion Criteria • Histologically confirmed locally advanced cervical cancer (FIGO IB2 to IIIB) • Age 18-70 years • ECOG performance status 02 • Adequate organ function (renal, hepatic, hematologic) • No prior treatment for cervical cancer Exclusion Criteria • Distant metastasis or recurrent cervical cancer • Pregnancy or lactation • Severe comorbidities contraindicating chemotherapy or radiotherapy • Known hypersensitivity to cisplatin or paclitaxel • Previous malignancy within 5 years (except non-melanoma skin cancer) Statistical Analysis Continuous variables were expressed as mean ± standard deviation or median with interquartile range, while categorical variables were presented as frequencies and percentages. The clinical response rates before and after treatment were compared using the Chi-square test or Fisher’s exact test as appropriate. Survival outcomes, including progression-free survival (PFS) and overall survival (OS), were estimated using the Kaplan-Meier method, and differences between groups were assessed with the log-rank test. A p-value of less than 0.05 was considered statistically significant throughout the analysis. Result International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Paul et al. International Journal of Current Pharmaceutical Review and Research 783 Table 1: Baseline Patient Characteristics (n=80) Baseline Patient Characteristic Value Age Age (mean ± SD, years) 49.2 ± 8.7 FIGO Stage IB2 20 (25%) IIA 15 (18.8%) IIB 30 (37.5%) IIIA 10 (12.5%) IIIB 5 (6.2%) Histology Squamous cell carcinoma 68 (85%) Adenocarcinoma 12 (15%) ECOG Performance Status 0–1 70 (87.5%) 2 10 (12.5%) Table 2: Treatment Response after Neoadjuvant Chemotherapy (n=80) Response Category Number (%) Complete Response (CR) 24 (30%) Partial Response (PR) 44 (55%) Stable Disease (SD) 10 (12.5%) Progressive Disease (PD) 2 (2.5%) Table 3: Comparison of Tumor Size Before and After Neoadjuvant Chemotherapy Parameter Before NACT (cm) Mean ± SD After NACT (cm) Mean ± SD p-value Tumor Size 5.4 ± 1.2 3.2 ± 1.0 <0.001 Table 4: Toxicity Profile During Neoadjuvant Chemotherapy (n=80) Toxicity Grade 1–2, n (%) Grade 3–4, n (%) Hematological (Anemia) 30 (37.5%) 8 (10%) Neutropenia 18 (22.5%) 5 (6.3%) Nausea/Vomiting 40 (50%) 6 (7.5%) Peripheral Neuropathy 12 (15%) 3 (3.8%) Table 5. Survival Outcomes at 12 Months Follow-up Outcome Number (%) / Median (months) p-value Progression-Free Survival (PFS) Rate 58 (72.5%) — Overall Survival (OS) Rate 68 (85%) — PFS by Response (CR+PR vs SD+PD) Median PFS: 14 vs 8 months 0.002 (Log-rank test) OS by Response (CR+PR vs SD+PD) Median OS: 18 vs 11 months 0.004 (Log-rank test) Figure 1: Toxicity Profile During Neoadjuvant Chemotherapy (n=80) International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Paul et al. International Journal of Current Pharmaceutical Review and Research 784 Figure 2: Comparison of Tumor Size Before and After Neoadjuvant Chemotherapy The study enrolled 80 patients with locally advanced cervical cancer, with a mean age of 49.2 ± 8.7 years. The majority of patients presented with FIGO stage IIB (37.5%), followed by IB2 (25%), IIA (18.8%), IIIA (12.5%), and IIIB (6.2%). Histologically, squamous cell carcinoma was the predominant subtype, accounting for 85% of cases, while adenocarcinoma represented 15%. Most patients (87.5%) had an Eastern Cooperative Oncology Group (ECOG) performance status of 0–1. Following neoadjuvant chemotherapy with weekly cisplatin and paclitaxel, clinical evaluation showed that 30% of patients (n=24) achieved a complete response (CR), while 55% (n=44) demonstrated a partial response (PR). Stable disease (SD) was observed in 12.5% (n=10) of patients, and progressive disease (PD) occurred in 2.5% (n=2). An overall response rate (CR + PR) of 85%. The mean tumor size before neoadjuvant chemotherapy (NACT) was 5.4 ± 1.2 cm, which significantly decreased to 3.2 ± 1.0 cm after completion of NACT (p < 0.001). This statistically significant reduction demonstrates the effectiveness of weekly cisplatin and paclitaxel in shrinking tumor burden prior to chemoradiation. Neoadjuvant chemotherapy with weekly cisplatin and paclitaxel was generally well tolerated. Hematological toxicities included anemia, observed in 37.5% of patients with grade 1–2 severity and 10% experiencing grade 3–4 anemia. Neutropenia occurred in 22.5% of patients at grade 1–2 and 6.3% at grade 3–4. Non-hematological toxicities included nausea and vomiting in 50% of patients (grade 1–2) and 7.5% (grade 3–4). Peripheral neuropathy was noted in 15% of patients with mild to moderate symptoms and 3.8% with severe symptoms At a median follow-up of 12 months, the progression-free survival (PFS) rate was 72.5% (n=58), and the overall survival (OS) rate was 85% (n=68). Patients who achieved complete or partial response (CR+PR) after neoadjuvant chemotherapy exhibited significantly longer median PFS (14 months) compared to those with stable or progressive disease (SD+PD), who had a median PFS of 8 months (p = 0.002). Similarly, median OS was significantly improved in the CR+PR group at 18 months versus 11 months in the SD+PD group (p = 0.004). Discussion In this study of 80 patients with locally advanced cervical cancer (LACC), neoadjuvant chemotherapy (NACT) using weekly cisplatin and paclitaxel followed by chemoradiation showed promising clinical outcomes with a high overall response rate of 85%, significant tumor size reduction, acceptable toxicity, and encouraging survival rates. The mean age of 49.2 years and predominance of FIGO stage IIB align with demographic and clinical characteristics reported in similar cohorts [1,2]. Squamous cell carcinoma being the dominant histology (85%) is consistent with global cervical cancer epidemiology [3]. The overall response rate observed here, with 30% complete response (CR) and 55% partial response (PR), is comparable to results from Gupta et al. [4], who reported a 78% overall response following NACT with cisplatin and paclitaxel in LACC. Similarly, Ryu et al. [5] documented a 82% combined CR and PR rate using a similar regimen, underscoring the efficacy of weekly cisplatin and paclitaxel as neoadjuvant agents. The significant reduction in tumor size from 5.4 cm to 3.2 cm (p < 0.001) corroborates findings by Chen et al. [6], who noted substantial tumor shrinkage post-NACT, facilitating improved radiation delivery and local control. Regarding toxicity, the hematological and non-hematological adverse events observed were manageable and International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Paul et al. International Journal of Current Pharmaceutical Review and Research 785 consistent with previous reports [7,8]. For instance, Tangjitgamol et al. [7] described similar rates of grade 3–4 anemia and neutropenia, affirming the tolerability of this regimen. Peripheral neuropathy incidence in our study parallels the findings of Moore et al. [8], who emphasized the importance of monitoring neurotoxicity with paclitaxel. Survival outcomes in this study are encouraging, with a 12month progression-free survival (PFS) of 72.5% and overall survival (OS) of 85%. Notably, patients achieving CR or PR had significantly better median PFS (14 months) and OS (18 months) compared to those with stable or progressive disease, highlighting response to NACT as a prognostic marker. These findings are in agreement with Suresh et al. [9] and Arbyn et al. [10], who reported improved survival associated with good chemotherapy response in LACC. The integration of NACT with weekly cisplatin and paclitaxel before chemoradiation may provide multiple benefits, including tumor debulking, eradication of micrometastatic disease, and enhanced radiosensitization. However, some earlier randomized controlled trials have shown mixed results regarding survival advantage of NACT over standard chemoradiation alone, warranting further large-scale studies. Our study adds to the growing evidence supporting NACT’s role, especially in patients with bulky tumors or poor prognostic features. Conclusion This study demonstrates that neoadjuvant chemotherapy with weekly cisplatin and paclitaxel followed by standard chemoradiation is a feasible and effective treatment strategy for patients with locally advanced cervical cancer. The regimen achieved a high overall response rate with significant tumor size reduction, manageable toxicity, and encouraging short-term survival outcomes. Patients who responded well to neoadjuvant chemotherapy showed significantly improved progression-free and overall survival, underscoring the importance of tumor response as a prognostic indicator. The integration of neoadjuvant chemotherapy into the multimodal treatment of locally advanced disease, further large-scale randomized trials with longer follow-up are needed to confirm the long-term benefits and optimize treatment protocols. 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