Main Session
Sep
29
PQA 06 - Genitourinary Cancer, Gynecological Cancer, and Health Care Access and Engagement
3777 - Chemoradiotherapy Compliance and Toxicities Among Cervical Cancer Patients in a High HIV-Prevalence Population
Presenter(s)
Taylor Avery, BS - Cooper Medical School of Rowan University, Camden, NJ
T. Avery1, C. Kernell2, L. Malcolm3, B. Galal3, S. Grover4,5, and S. Bassa6; 1Cooper Medical School of Rowan University, Camden, NJ, 2University of Texas at Southwestern Medical School, Dallas, TX, 3Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 4Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, 5Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 6Head Radiation Oncology ,Steve Biko Academic Hospital ,University of Pretoria ,Gauteng,South Africa, Gauteng, South Africa
Purpose/Objective(s):
Concurrent chemoradiotherapy (CRT) with weekly cisplatin at 40 mg/m² is the global standard of care for locally advanced cervical cancer (LACC). In high HIV-prevalence, resource-limited settings, treatment tolerance remains a concern. Our institution in Pretoria, South Africa administers weekly cisplatin at a reduced dose of 30 mg/m² to improve tolerability and compliance. We evaluated factors associated with chemotherapy completion and acute toxicity in this setting.Materials/Methods:
We performed a retrospective analysis of women with LACC treated with definitive CRT and weekly cisplatin (30 mg/m²) between Jan 2022 and Dec 2023. Adequate compliance was defined as =4 cycles of cisplatin. Baseline variables were compared using Pearson’s chi-square or Fisher’s exact as appropriate. Univariable (UVA) and multivariable logistic regression (MVA) were performed to estimate odds ratios (ORs) for receipt of =4 cycles.Results:
The median age of patients (n=231) was 45.0 years (IQR: 39-53), and 126 (55%) were HIV-positive. The majority (n=136, 59%) of patients presented with Stage IIIA-IVB disease, followed by 41%% (n=94) with Stage IB-IIB disease. The median number of cisplatin cycles delivered was 4 (IQR 3–4), with 126 (55%) completing =4 cycles. On UVA, HIV-positive status was associated with decreased odds of receiving =4 cycles (OR 0.46, 95% CI 0.26–0.80, p=0.006). This association remained significant on MVA (OR 0.46, 95% CI 0.23–0.88, p=0.022). No other clinical or laboratory variables were independently associated with chemotherapy completion. The most common reasons reported for not receiving chemotherapy were anemia (n=42, 18%), neutropenia (n=44, 19%), and renal toxicity (n=32, 14%). There was no difference in these reported reasons between HIV-positive and HIV-negative patients. Among patients receiving <4 cycles, HIV-positive patients were younger than HIV-negative patients (median 45 vs 53 years, p=0.030). There were no differences among HIV-positive and HIV-negative patients regarding reported hematologic or renal toxicity, disease stage, ECOG PS, or baseline hemoglobin, creatinine, or hydronephrosis status.Conclusion:
Despite use of a reduced weekly cisplatin dose (30 mg/m²) intended to enhance tolerability, HIV-positive status remained independently associated with lower odds of completing =4 cycles. Although patients receiving fewer cycles experienced greater toxicity overall, there was no difference in toxicities among HIV-positive vs HIV-negative patients. These findings suggest that reduced chemotherapy delivery among HIV-positive women may not be fully explained by measurable toxicity. Prospective studies incorporating standardized CTCAE grading and evaluation of system- and provider-level factors are warranted to better understand barriers to equitable chemotherapy delivery in high HIV-prevalence settings.