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Review
. 2023 Nov;25(11):1307-1326.
doi: 10.1007/s11912-023-01463-9. Epub 2023 Oct 23.

Advances in the Management of Recurrent Cervical Cancer: State of the Art and Future Perspectives

Elena Giudice  1 , Mansoor Raza Mirza  2 , Domenica Lorusso  3   4
Affiliations
Review

Advances in the Management of Recurrent Cervical Cancer: State of the Art and Future Perspectives

Elena Giudice et al. Curr Oncol Rep. 2023 Nov.

Abstract

Purpose of review: This review aims to give an insight into the currently available options for recurrent/metastatic (R/M) cervical cancer (CC), along with the main future, potentially practice-changing perspectives in this field.

Recent findings: Improvements in terms of tumor responses were observed with the use of immune checkpoints inhibitors (ICIs) in the previously treated CC population, followed by emerging striking data in terms of both antitumor activity and survival rates with the addition of the ICIs to platinum-based chemotherapy with or without bevacizumab in the first-line setting. Furthermore, the CC treatment landscape took another step forward in 2021 with the introduction of antibody-drug conjugates (ADCs) in the second-line setting, a highly targeted therapeutic strategy, which demonstrated to be a valid alternative option in the recurrent setting. R/M CC is a hard-to-treat disease. However, after several years of limited systemic therapeutic options for the recurrent setting, the year 2018 marked a turning point for R/M CC patients, with the introduction of immunotherapy in the treatment paradigm, which completely reshaped the therapeutic armamentarium of the disease. Besides, another valuable treatment option represented by ADCs demonstrated its efficacy in the recurrent setting, thus further widening the treatment landscape for those patients. Yet, the introduction of immunotherapy in the upfront setting brought along new issues to be addressed such as the emerging ICIs resistance and the following need for alternative options in the post-ICIs setting. Several innovative therapeutic strategies are under investigation in ongoing clinical trials, with the aim of overcoming ICIs resistance with the addition of immunomodulatory agents or bypassing the ICIs resistance with novel alternative drugs.

Keywords: Cervical cancer; Immune checkpoint inhibitors; Immunotherapy; PD-L1; ADC.

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Conflict of interest statement

Dr. Lorusso reports consulting or advisory role at PharmaMar, Merck Serono, Novartis; speakers’ bureau fees from AstraZeneca, Clovis Oncology, PharmaMar, and Tesaro/GSK; research funding (to institution) from Clovis Oncology, Merck, PharmaMar, and Tesaro/GSK; personal financial interest in AstraZeneca, Clovis Oncology, PharmaMar, Roche, and Tesaro/GSK; Honoraria from AstraZeneca, Clovis Oncology, Genmab, Immunogen, Merck, Roche, and Tesaro/GSK; Expert testimony on behalf of Clovis Oncology. Dr. Mirza reports consulting or advisory role at Astra Zeneca, Biocad, BioNTech, Boehringer Ingelheim, Gilead, GSK, Karyopharm, Merck, Roche, Zailab, Regeneron, Exelixis; speakers’ bureau fees from AstraZeneca and GSK; research funding (to institution) from Apexigen, AstraZeneca, Deciphera (trial chair), GSK, and Ultimovacs; and personal financial interest in Karyopharm, Sera Prognostics (stocks/shares, member of Board of Directors). Dr. Giudice has nothing to disclose.

Figures

Fig. 1
Fig. 1
Present and future therapeutic strategies for the treatment of recurrent/metastatic cervical cancer (R/M CC). Programabsmed death-ligand 1 (PD-L1); cisplatin (CDDP); Carboplatin (CBDCA); Paclitaxel (PTX); Bevacizumab (Bev); human papillomavirus (HPV); tumor-infiltrating lymphocytes (TILs); chimeric antigen receptor (CAR); cluster of differentiation-22 (CD22); prostate-specific membrane antigen (PSMA); Mucin 1 (MUC1)
See this image and copyright information in PMC

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