Efficacy of induction chemotherapy during the COVID-19 pandemic for treatment of locally advanced cervical cancer in Botswana.

Objectives: Standard chemoradiation (CRT) treatment for cervical cancer was disrupted in Botswana during the COVID-19 pandemic. Patients were prescribed induction chemotherapy (IC) to bridge delays to radiotherapy (RT) or CRT (IC + RT/CRT).

Methods: This prospective observational study compared outcomes of locally advanced cervical cancer patients who received IC + RT/CRT (n = 67) between 2019 and 2022 to historical controls who received CRT (n = 169) between 2014 and 2019. IC + RT/CRT consisted of four cycles of paclitaxel 175 mg/m and carboplatin (area under the curve 5-6) prescribed once every three weeks followed by external beam RT and high-dose-rate brachytherapy with or without weekly concurrent cisplatin. Two-year overall survival (OS) was estimated using the Kaplan-Meier method; univariable and multivariable analyses (MVA) were conducted using Cox proportional hazards regression.

Results: Median follow-up was 28.9 months (95 % CI 27.4-32.7 months). Two-year OS of the IC + RT/CRT cohort (80.2 % [95 % CI: 69.8-92.1 %]) did not differ from the historical CRT cohort (77.5 % [95 % CI 71.3-84.1 %]). Improved OS was associated with receiving ≥3 cycles of IC on MVA. Secondary analysis among those prescribed IC + RT/CRT (n = 91) demonstrated no difference in 2-year OS (66.8 % [95 % CI: 56.9-78.3 %]) compared to CRT historical controls. Receipt of the prescribed IC + RT/CRT was associated with increased OS on MVA.

Conclusions: Survival of patients who received IC + RT/CRT did not differ from historical CRT controls and was associated with ≥3 cycles of IC, suggesting that IC may be a feasible treatment pathway when RT is delayed.