Hypoxic cell sensitization in chemoradiation for cervical cancer

The integration of cisplatin into radiation regimens was first developed in locally advanced cervical cancer, a tumour where there is the added advantage that high dose intracavity radiation can be given as well as external beam therapy (1), and the concept was later extended to head and neck cancers. However, progress since then has been slow with the addition of other radiosensitising drugs like gemcitabine providing only a modest survival advantage (2). Myelosuppression and gastrointestinal toxicity also became dose limiting with the doublet. DiSilvestro and colleagues reported a phase III trial of cisplatin based chemoradiation with or without the hypoxic cell sensitizer tirapazamine in 402 predominantly Caucasian and non-Hispanic patients with stages IB, IIa, IIIB and IVa cervical cancer in 2014 (3). The GOG 219 study took 3.5 years to accrue and was closed in 2009 prematurely on account of lack of study drug.