Predicting response to neoadjuvant chemotherapy in patients with cervical carcinoma: can we do without any longer?

The aim of the study was to identify variables that may predict the respons e to neoadjuvant chemotherapy (NACT) in patients with cervical cancer as ma turing data from the literature indicate that this therapeutic strategy mig ht be beneficial to some but harmful to others. Clinicopathologic variables including age, histology, tumor differentiation, as well as immunohistoche mical overexpression of p53, mdm2, c-erbB-2, and cathepsin D in 37 of these patients were evaluated as possible predictors of response to the NACT. Fi fty-five patients with stage IIB cervical cancer submitted to two courses o f cisplatin/ifosfamide/mesna prior to definitive treatment with radical sur gery or radiation therapy were the subjects of this study. The clinical response rate was 80% but none of the variables was able to pr edict response to NACT. Unless methods are found enabling us to predict res ponse and therefore to identify those patients that could benefit from incl uding NACT in the treatment of locally advanced cervical cancer, only women with primarily resectable tumors should be selected for this multimodality approach as a result of the possibility of cross-resistance with radiation therapy in nonresponders.