Tri-Weekly Cisplatin Matches Weekly Dosing With Better Tolerability in Cervical Cancer

Clinical Summary: 

• Design/Population: This randomized clinical trial evaluated weekly versus tri-weekly cisplatin given with radiotherapy in 314 patients with stage IIB to IVA cervical cancer.
• Key Outcomes: Tri-weekly cisplatin achieved similar recurrence-free survival compared with weekly dosing, with fewer high-grade hematologic toxicities and improved quality of life.
• Clinical Relevance: Tri-weekly cisplatin represents a viable alternative to weekly dosing, offering comparable efficacy with improved tolerability in patients undergoing chemoradiotherapy.

Results from the phase 3 TACO trial demonstrated that tri-weekly cisplatin-based chemoradiotherapy provides similar survival outcomes with improved tolerability compared with weekly dosing among patients with locally advanced cervical cancer.

“The standard treatment for locally advanced cervical cancer is cisplatin-based chemoradiotherapy,” stated Sang-Young Ryu, MD, PhD, Korea Institute of Radiological & Medical Science, Seoul, Korea, and coauthors. “However, the optimal dose and dosing schedule of cisplatin remain debated.” 

In this study, 314 patients with stage IIB to IVA cervical cancer were randomized 1:1 to receive either 40 mg/m² of weekly cisplatin for 6 cycles or 75 mg/m² of cisplatin once every 3 weeks for 3 cycles, both given concurrently with radiotherapy. The primary end point was 3-year recurrence-free survival (RFS). Key secondary end points included overall survival (OS) and safety. 

At analysis, chemotherapy delays were more frequent in the weekly arm compared with the tri-weekly arm (P = .008). The 3-year RFS rate was 78.7% in the weekly cisplatin arm and 84.1% in the tri-weekly cisplatin arm, with no statistically significant difference between groups (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.39 to 1.32; P = .28). Patterns of recurrence were also similar between arms.

The tri-weekly cisplatin regimen was associated with a more favorable safety profile, with significantly lower rates of grade 3/4 hematologic toxicities (P <.001). Patients receiving tri-weekly cisplatin also reported improved quality-of-life scores across multiple domains. 

“Tri-weekly cisplatin-based chemoradiotherapy was not statistically superior to a weekly schedule in terms of survival outcomes for patients with locally advanced cervical cancer,” concluded Dr Ryu et al. “These results suggest tri-weekly cisplatin administration as a feasible alternative for chemoradiotherapy in cervical cancer.”

Source: 

Ryu SY, Nam BH, Kim MH, et al. A randomized phase III clinical trial of weekly versus tri-weekly cisplatin-based chemoradiotherapy for locally advanced cervical cancer: Results of the TACO (GCIG/KGOG 1027/THAI 2012) study. ESMO Open. Published online: March 10, 2026. doi:10.1016/j.esmoop.2026.106102