Prognostic factors for response to cisplatin-based chemotherapy in advanced cervical carcinoma: a Gynecologic Oncology Group Study.
OBJECTIVE
Cisplatin-based combination chemotherapy is considered standard treatment for advanced/recurrent cervical carcinoma; however, the majority of patients do not respond. This study was undertaken to identify the prognostic factors and develop a model predictive of (non-) response to chemotherapy.


METHODS
Four-hundred twenty-eight patients with advanced cervical cancer who received a cisplatin-containing combination in three Gynecologic Oncology Group (GOG) protocols (110, 169 and 179) were evaluated for baseline clinical characteristics and multivariate analysis was conducted to identify factors independently prognostic predictive of response using a Logistic regression model. A predictive model was developed and externally validated using an independent GOG protocol (149) data.


RESULTS
Multivariate analysis identified five factors (African-American, performance status [PS] >0, pelvic disease, prior radiosensitizer and time interval from diagnosis to first recurrence <1 year) independently prognostic of poor response. A simple prognostic index was derived based on the total number of risk factors. When patients were classified into three risk groups (low risk: 0-1 factor; mid risk: 2-3 factors; high risk: 4-5 factors), patients with 4-5 risk factors were estimated to have a response rate of only 13%, and median progression-free and overall survival of 2.8 months and 5.5 months, respectively. The accuracy of the index was supported by both internal and external datasets.


CONCLUSIONS
A simple index based on five prognostic factors may have utility in clinical practice to identify the women who are not likely to respond to the cisplatin-containing regimens. This subgroup of patients should be considered for non-cisplatin chemotherapy or investigational trials.
Moore
David H
DH
Gynecologic Oncology of Indiana, 5255 East Stop 11 Road, Suite 310, Indianapolis, IN 46237, USA. Dhrrym@aol.com
Tian
Chunqiao
C
Monk
Bradley J
BJ
Long
Harry J
HJ
Omura
George A
GA
Bloss
Jeffrey D
JD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D016015:Logistic Models; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D017239:Paclitaxel / Q000008:administration & dosage; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D019772:Topotecan / Q000008:administration & dosage; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy*; D055815:Young Adult
D001761:Bleomycin; D019772:Topotecan; D017239:Paclitaxel; D002945:Cisplatin; D007069:Ifosfamide