The Interlace trial studied the effect of adding induction chemotherapy to standard chemoradiotherapy in patients with locally advanced cervical cancer, involving 500 participants across 32 medical centers globally. Results indicated improved progression-free survival (72% vs. 64%) and overall survival (80% vs. 72%) in the combined treatment arm, although there was increased toxicity associated with induction chemotherapy. Overall, the findings suggest that the combination of induction chemotherapy followed by chemoradiotherapy may become a new standard of care for this patient group.

1. SBRT LUNG
Dr Kanhu Charan Patro
MD,DNB(Radiation Oncology),MBA,FICRO,FAROI(USA),PDCR,CEPC
Clinical Director, HOD (Radiation Oncology)
ISRo- Institute of Stereotactic Radiation oncology
Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam
drkcpatro@gmail.com /M- +91-9160470564/ www.drkanhupatro.com
Let’s analyze INTERLACE

2. INTERLACE Trial
Induction Chemotherapy
followed by Chemoradiotherapy
vs Chemoradiotherapy Alone

3. INTRODUCTION
1. The INTERLACE trial investigates the effect of adding induction chemotherapy to
standard chemo-radiotherapy in locally advanced cervical cancer to improve
progression-free and overall survival.
2. Trial conducted at 32 medical centers globally, including Brazil, India, Italy, Mexico,
and the UK.

4. Which journal?
Lancet Oncology

5. Who is the author?
Multicentric

6. Which group?
INTERLACE GROUP

7. Where?
Multicentric

8. TYPE OF STUDY?
Multicentric

9. TYPE OF STUDY?

10. What is the basis of the study?
Metaanalysis/CXII study

11. Ethics adherence?

12. Funding?

13. Trial design

15. Inclusion and exclusion

16. Randomization

17. Trial profile
ITT

18. TREATMENT DETAILS

19. Study Design and Participants
• Study Population:
• Stage IB1 with nodal involvement to Stage IVA cervical
cancer (FIGO 2008 staging)
• Randomized Phase 3 trial with 500 patients
• Treatment arms:
• Induction chemotherapy (Carboplatin + Paclitaxel for 6
weeks) followed by chemoradiotherapy (cisplatin-based)
• Chemoradiotherapy alone (cisplatin-based)

20. Radiotherapy details

21. Follow up

22. End points

23. PRIMARY END POINTS
1. Progression-Free Survival (PFS): Time from randomization to progression
or death.
2. Overall Survival (OS): Time from randomization to death from any cause.

24. SECONDARY END POINTS
1. Adverse events (Grade 3–4 toxicity)
2. Patterns of relapse (local vs distant metastasis)
3. Quality of Life (QoL) assessed with EORTC QLQ-C30 and CX24 modules

25. Statistical analysis

26. Statistical analysis

27. Analysis

28. Study period

29. Demographic analysis

30. Demographic analysis

31. Adherence to chemotherapy

32. Adherence to radiotherapy

33. Adherence to radiotherapy

34. CENTRAL REVIEW

35. MEDIAN FOLLOW UP

36. KEY RESULTS
• 5-year PFS: 72% (NACT + CTRT) vs 64% (CTRT alone)
• 5-year OS: 80% (NACT + CTRT) vs 72% (CTRT alone)
• Distant metastasis: 7% (NACT + CTRT) vs 12% (CTRT alone)
• Grade 3–4 toxicity: 59% (NACT + CTRT) vs 48% (CTRT alone)

37. Kaplan–Meier PFS analysis

38. Kaplan–Meier OS analysis

39. Distance recurrence

40. Pa nodal recurrence

41. Adverse event analysis

42. TOXICITY
1. Higher hematological toxicity in NACT arm (30% Grade 3–4 vs 13% in CTRT arm)
2. Main toxicities: Neutropenia (19% vs 5%), Anemia (28% vs 17%)
3. Non-hematological toxicities were similar between both groups

43. DEATH
There were 3 deaths within 30 days of completing
treatment, one (respiratory failure) in the
induction chemotherapy with chemoradiotherapy
group, and 2 in the chemoradiotherapy alone
group (sepsis and pulmonary embolism); none
were considered treatment-related.

44. QOL
1.Temporary decline in QoL during
induction chemotherapy phase
2.No long-term differences between
the two groups after treatment

45. What are the criticisms?

46. What are the criticisms?

47. Strong Points favoring the study
1. This is a phase 3 study
2. Electronic randomization of 500 patients.
3. It was a Multicentric study involving around 32 nations.
4. ITT analysis
5. Significance level at 0.05
6. Power is level at 80%
7. Central review of radiation details

48. Negative Points of the study
1. FIGO 2008 staging was used to stage the patient prior to allocating the
treatment arm.
2. Acute toxicity was higher in the NACT arm
3. Adherence to concurrent chemotherapy during radiotherapy was hindered in
the NACT arm, resulting in deviation from the standard of care treatment.
4. The increase in overall treatment time in the NACT arm is a concern.
5. Temporary decline in the QOL is present in the NACT arm.
6. 10 percent lost to follow up

49. Is it practice changing?

50. SUMMARY
1. NACT followed by CTRT showed improved progression-free and overall survival
compared to CTRT alone.
2. Increased toxicity in the NACT arm but manageable with standard care.
3. NACT + CTRT can be considered as a new standard of care for locally advanced
cervical cancer.