OnCo
pairingsPairing

Induction chemotherapy → chemoradiation (locally advanced cervical cancer)

Six weeks of cheap chemotherapy before chemoradiation cut deaths by 40% (INTERLACE), while chemotherapy after chemoradiation did nothing (OUTBACK). Order matters.

INTERLACE: 5-year OS 80% vs 72% (HR 0.60). OUTBACK: no benefit from adjuvant chemotherapy and much more toxicity. Induction is deliverable in low- and middle-income countries where pembrolizumab is not.

Carboplatin→ thenIMRT / IGRT (modern external beam)sequence
Rationale
Early systemic control of micrometastases while patients are fit; adjuvant chemotherapy after radiation suffers poor compliance and marrow toxicity.
Evidence
One positive phase 3 (induction) and one negative phase 3 (adjuvant).

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cancers

1
Cervical cancer

technologies

2
BrachytherapyIMRT / IGRT (modern external beam)

drugs

1
ApprovedCytotoxic chemotherapy (platinum)
Carboplatin

trials

2
INTERLACEOUTBACK / ANZGOG 0902 / GOG-0274