Purpose: The purpose was to compare feasibility, tolerability, toxicity and local control of concomitant chemoradiation with weekly cisplatin and erlotinib versus concomitant chemoradiation with weekly cisplatin in EGFR positive locally advanced carcinoma cervix.

Material and Methods: In this prospective, comparative study, 60 histopathologically proven locally advanced carcinoma cervix patients with EGFR positivity received either Erlotinib (150 mg/day) with concomitant chemoradiation (study group) or CCRT (control group). Treatment with CCRT included cisplatin 40 mg/m2 intravenously weekly concurrently with external beam radiation(50 Gy in 25 fractions over 5 weeks) followed by intracavitary HDR brachytherapy (7Gy to point A three times, once in a week). Tumor response was calculated as per the WHO criteria. The treatment induced toxicity such as anaemia, leucopenia and nausea/vomiting were graded as per WHO criteria. Skin reaction, diarrhea and genioturinary toxicity were graded as per RTOG criteria.

Results: Overall, complete response was seen in 93% in study group and 86% in control group at the end of treatment. In stage IIB and IIIA, complete response was observed in 100% of patients in the study and control group. Sixty percent patients with stage IIIB in study group and control group had complete response. Forty percent patients with stage IIIB in two groups showed partial response. At last follow up, 93% patients in study group and 80% patients in control group were observed to be free of disease. There were 7% and 10% patients with residual disease in study group and control group respectively. Distant recurrence was seen in 10% patients in control group. Even though response was better in study group but the difference in two groups was not statistically significant.

The toxicities commonly encountered in both the treatment groups were majority of Grade I/II. A higher incidence of nausea, vomiting, diarrhea and skin rash was noted in the Erlotinib plus CCRT group in comparison CRT. No Grades 4 and 5 toxicity was observed in Erlotinib with CCRT. Erlotinib was observed to be safe with manageable toxicity profile.

Conclusion: Addition of Erlotinib to standard cisplatin-based CCRT showed improved tumor response in comparison to cisplatin-based CRT alone in treatment of locally advanced carcinoma cervix, although not statistically significant with manageable toxicity.

Keywords: Advanced, Carcinoma, Cervix, Epidermal growth factor receptor, Erlotinib, Tyrosine kinase inhibitor

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Dr Jyoti Pannu

Junior Resident, Department of Radiotherapy, Post-graduate Institute of Medical Sciences, Rohtak (INDIA)

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