A 38-year-old woman from rural India presents with stage IB cervical cancer (tumour size 2.5 cm, confined to cervix). She is fit for surgery and wishes to preserve ovarian function. What is the drug of choice for neoadjuvant chemotherapy prior to radical hysterectomy?

Explanation

## Neoadjuvant Chemotherapy for Early-Stage Cervical Cancer **Key Point:** Cisplatin-based combination chemotherapy is the standard neoadjuvant regimen for stage IB cervical cancer prior to radical hysterectomy, particularly when tumour size is ≥2 cm or when there are high-risk features. ### Rationale for Cisplatin + Paclitaxel **High-Yield:** The combination of cisplatin and paclitaxel (TP regimen) is preferred over cisplatin monotherapy because: - Improved response rates and disease-free survival compared to cisplatin alone - Synergistic cytotoxic effect: cisplatin causes DNA cross-linking; paclitaxel stabilizes microtubules - Better tumour downsizing before surgery, reducing operative morbidity - Standard regimen in international trials (e.g., EORTC, GOG protocols) ### Dosing & Administration - Cisplatin: 75 mg/m² IV on day 1 - Paclitaxel: 175 mg/m² IV on day 1 - Repeat every 21 days for 3–4 cycles ### Why Preserve Ovarian Function? **Clinical Pearl:** In premenopausal women with early-stage cervical cancer, ovarian transposition (oophoropexy) before pelvic radiation is considered to preserve fertility and avoid surgical menopause. Neoadjuvant chemotherapy allows tumour downstaging, potentially reducing the need for postoperative radiation and thus the indication for ovarian transposition. ### Comparison with Other Regimens | Regimen | Role | Limitation | |---------|------|----------| | Cisplatin monotherapy | Historical standard | Lower response rates; inferior OS vs. combination | | Cisplatin + Paclitaxel | **Neoadjuvant for IB (≥2 cm) and IIA** | **PREFERRED** | | Carboplatin + Gemcitabine | Recurrent/metastatic disease; cisplatin-ineligible | Not standard for neoadjuvant setting | | Topotecan monotherapy | Recurrent disease (with cisplatin) | No role in neoadjuvant therapy | **Mnemonic:** **NACT-CC** = **N**eoadjuvant **A**djuvant **C**hemotherapy for **C**ervical **C**ancer = **Cisplatin + Paclitaxel**. [cite:FIGO Guidelines 2019, Gynecologic Oncology]