Real-world feasibility and hematologic toxicity of induction chemotherapy in advanced cervical cancer in a resource-limited setting.

Abstract

e13634 Background: Induction chemotherapy has reshaped the treatment paradigm for locally advanced cervical cancer (LACC), demonstrating overall survival benefit. However, feasibility and toxicity management may be challenging in low-resource settings, potentially limiting reproducibility. Real-world data from these contexts are needed. Methods: This retrospective observational study included women ≥18 years with cervical cancer stages IB3–IVA (FIGO 2018) treated per the INTERLACE protocol in a low-resource population (January 2024–June 2025). Induction chemotherapy consisted of weekly carboplatin (AUC 2) and paclitaxel (80 mg/m²) for six weeks, followed by 3D conformal radiotherapy with concurrent weekly cisplatin and intracavitary brachytherapy (2D point A). Clinical-pathological data, treatment adherence, toxicity (CTCAE v5.0), and MRI-based response were collected. Analysis was descriptive. Results: Thirty-five patients were evaluated (median age 43.4 years). Squamous carcinoma predominated (85.7%), and 71.4% had stage II disease. Six induction cycles were completed in 80% of patients; 82.9% received ≥5 cycles. Median time to radiotherapy was 12 days (7–55). Concurrent cisplatin (≥5 cycles) was completed by 54.3%. Grade 3–4 hematologic toxicity occurred in 20% during induction and 22% during chemoradiotherapy. Anemia occurred in 77.1% (G3–4:12%) and 91.1% (G3–4:6%), respectively; 57.1% required transfusion. Grade 3–4 neutropenia occurred in 22%, including two cases of febrile neutropenia. Toxicities were manageable, with no treatment-related deaths. The overall response rate was 88.5%. Conclusions: In a resource-limited public system, INTERLACE implementation demands structured planning and close monitoring. High hematologic toxicity and transfusional needs underscore care delivery challenges, and suboptimal local treatment may affect long-term outcomes. Grade 3–4 treatment-related adverse events. Toxicity During Induction Chemotherapyn (%) During Concurrent Chemoradiotherapyn (%) Grade 3–4 hematologic adverse events 7 (20) 8 (22) Neutropenia 3 (8) 5 (14) Anemia 4 (12) 2 (6) Thrombocytopenia 0 1 (3) Any grade 3–4 non-hematologic adverse event 4 (11) 0 Bronchospasm 1 (3) 0 Diarrhea 1 (3) 0 Infection 1 (3) 0 Peripheral neuropathy 1 (3) 0