Impact of interruptions in chemotherapy on survival for patients with metastatic or recurrent cervical cancer.

Abstract

e17522 Background: Chemotherapy interruptions in metastatic cervical cancer are not an infrequent event. Interruptions in treatment of solid tumors have been associated with adverse survival outcomes. Our objective was to determine the impact of treatment interruption during first line systemic chemotherapy on survival in patients with metastatic or recurrent cervical cancer. Methods: An IRB approved retrospective cohort study was designed to identify patients with metastatic (stage IVB) or recurrent cervical cancer treated at our institutions from January 2008 through December 2024. Demographics, clinicopathologic information, first line chemotherapy regimens, associated delays and outcome measures were abstracted from medical records. Exclusion criteria included neuroendocrine histology; refusal or non-initiation of treatment on diagnosis of recurrence, or death; and insufficient clinical data. Delays were categorized as modifiable (social determinants of health, logistics, treatment break) and non-modifiable (cytopenias, organ dysfunction, chemotherapy reaction, infection, ECOG status). Data were analyzed using descriptive statistics, Kaplan-Meier survival estimate, and log-rank tests to calculate significance (p<0.05). Primary endpoints were progression free survival during first line chemotherapy and overall survival. Results: 204 patients with metastatic or recurrent cervical cancer met inclusion criteria. Clinical and demographic attributes of patients are presented in Table 1. A total of 1,833 cycles of first line chemotherapy were completed with 633 interruption events. There were 308 modifiable and 325 non-modifiable interruption events. Median total, modifiable, and non-modifiable interruption events per patient was 2 events. Median number of days a cycle was interrupted was 7 days (1-259). There was no difference in survival between patients with or without interruptions in treatment. However, patients who had modifiable treatment interruptions had a significantly better overall survival compared to those with non-modifiable treatment interruptions (HR 0.60, 95% CI [0.38-0.93], p<0.05). Conclusions: Treatment interruptions during first line systemic chemotherapy for metastatic or recurrent cervical cancer do not affect survival. Demographics and clinical attributes of evaluable patients with stage IVB or recurrent cervical cancer (n=204). Characteristic Median age at diagnosis of IVB or recurrence, years 54.5 (22-81) Race, n (%) White/CaucasianBlack/African AmericanAsianNative American/Alaska Native/Multiracial/Other 149 (73.04)45 (22.06)5 (2.45)5 (2.45) Metastatic (IVB) disease 74 Recurrent disease after surveillance 130 Histology, n (%) Squamous cell carcinomaAdenocarcinomaAdenosquamous carcinomaOther 149 (73.04)40 (19.61)4 (1.96)11 (5.39)