108 A recent study exploring oral triapine in combination with cisplatin-based chemoradiation has shown encouraging findings for treating locally advanced cervical and vaginal cancers. Researchers aimed to identify a more effective, convenient regimen for patients facing these challenging diagnoses. The findings were published in the journal Cancer Chemotherapy and Pharmacology. The trial focused on patients with stage IB2 to IVA cervical cancer or comparable stages of vaginal cancer, where traditional surgical options are not viable. Triapine, an inhibitor of ribonucleotide reductase, enhances the sensitivity of cancer cells to radiation and chemotherapy by targeting critical DNA repair pathways. While intravenous triapine has been tested previously, the new oral formulation offers the potential for greater convenience and alignment with daily treatment schedules. The phase I trial, which involved 21 participants, established the maximum tolerated dose for oral triapine at 100 mg daily during radiation therapy. Although 150 mg doses were initially tested, they resulted in higher incidences of adverse events, including significant haematological toxicities. Researchers selected the 100 mg dose for further study, demonstrating a favourable balance between efficacy and safety. Treatment outcomes were measured through PET scans three months post-therapy, revealing a metabolic complete response in approximately 69% of evaluable patients. Although these results are slightly lower than those reported in trials of intravenous triapine, the study population included individuals with advanced disease stages and less favourable histologies, potentially influencing response rates. One of the unique aspects of this study was its emphasis on oral triapine’s pharmacokinetics. The drug exhibited a bioavailability of 59%, with significant variability in absorption rates among patients. Notably, smoking was found to nearly double the clearance of triapine, prompting researchers to recommend further investigations into personalised dosing strategies for smokers. Adverse events associated with the treatment were consistent with expectations for cisplatin-based chemoradiation, including reduced blood cell counts, fatigue, and gastrointestinal side effects. A specific concern was methemoglobinemia, a condition linked to triapine, which was successfully managed through protocol adjustments and avoidance of interacting medications. This study represents a step forward in cancer treatment, particularly for patients with limited options. Oral triapine’s integration into daily radiation sessions simplifies the regimen and aligns peak drug levels with treatment times. The findings suggest a viable pathway for improving outcomes while reducing the burden on patients, though larger trials will be necessary to confirm these preliminary results and refine dosing guidelines. Further research could address long-term survival benefits and explore the potential of triapine in combination with emerging therapeutic modalities. As treatment protocols evolve, this study underscores the importance of innovation in addressing unmet needs for individuals battling advanced cervical and vaginal cancers.