Current complex treatment for cervical cancer

Česká verze

Authors: R. Soumarová; J. Havlík
Authors place of work: Onkologická klinika 3. LF UK a FN Královské Vinohrady, Praha
Published in the journal: Klin Onkol 2025; 38(3): 185-191
Category: Přehledy
doi: https://doi.org/10.48095/ccko2025185

Summary

Background: Cervical cancer has shown declining incidence and mortality in recent years, yet it remains a serious societal problem. This is mainly due to its prevalence in younger age groups and the relatively difficult treatment of advanced stages. Treatment of the early stages is predominantly in the hands of gynecologists, while modern radiation therapy combined with systemic therapy is now the standard treatment for advanced stages. More controversial is the indication and position of neoadjuvant systemic therapy before surgery or radiotherapy. In addition to chemotherapy, the role of immunotherapy in metastatic disease is increasing. The addition of immunotherapy to radiation therapy in locally advanced disease also improves oncological outcomes. Aim: This article summarizes current primarily nonsurgical therapies and outlines directions in the treatment of cervical cancer.

Keywords:

brachytherapy – external beam radiotherapy – pembrolizumab – early cervical cancer – locally advanced cervical cancer

Zdroje

1. SVOD. Epidemiologie zhoubného novotvaru hrdla děložního (C53). Národní onkologický registr České republiky. [online]. Dostupné z: https: //www.svod.cz/res/file/karty-diagnoz/c53.pdf.

2. Linkos. Zhoubný novotvar hrdla děložního (C53). [online]. Dostupné z: https: //www.linkos.cz/lekar-a-multidisciplinarni-tym/personalizovana-onkologie/modra-kniha-cos/aktualni-vydani-modre-knihy/asd-15-zhoubny-novotvar-hrdla-delozniho-c53/.

3. Shirali E, Yarandi F, Behtash N et al. Neoadjuvant chemotherapy in cervical cancer: a review article. J Obstet Gynecol Cancer Res 2018; 3 (2): 87–91.

4. Robova H, Rob L, Charvat M et al. Neoadjuvant chemotherapy in early stage cervical cancer before fertility sparing surgery. Int J Gynecol Cancer 2006; 16 (Suppl 3): 710–711. doi: 10.1136/ijgc-00009577-200610001-00389.

5. Radiation Therapy Oncology Group. EMBRACE II: a prospective, multi-center, phase III trial of image-guided intensity-modulated radiotherapy with concurrent cisplatin for locally advanced cervical cancer. Lancet Oncol 2020; 21 (5): 637–646. doi: 10.1016/S1470-2045 (20) 30297-3.

6. Pötter R, Tanderup K, Kirisits C et al. The EMBRACE II study: the outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clin Transl Radiat Oncol 2018; 9: 48–60. doi: 10.1016/j.ctro.2018.01.001.

7. National Institutes of Health. NCI issues clinical announcement on cervical cancer: chemotherapy plus radiation improves survival. [online]. Dostupné z: https: //www3.scienceblog.com/community/older/archives/B/nih478.html.

8. Duska LR, Randall LM. Progress in the treatment paradigms for locally advanced cervical cancer. Lancet 2024; 404 (10462): 1494–1496. doi: 10.1016/S0140-6736 (24) 02101-9.

9. DiSilvestro PA, Shamshad A, Craighead PS et al. Phase III randomized trial of weekly cisplatin and irradiation versus cisplatin and tirapazamine and irradiation in stages IB2, IIA, IIB, IIIB, and IVA cervical carcinoma limited to the pelvis: a Gynecologic Oncology Group study. J Clin Oncol 2014; 32 (5): 458–464. doi: 10.1200/JCO.2013.51. 4265.

10. Mileshkin LR, Moore KN, Barnes EH et al. Adjuvant chemotherapy following chemoradiotherapy as primary treatment for locally advanced cervical cancer versus chemoradiotherapy alone (OUTBACK): an international, open-label, randomised, phase 3 trial. Lancet Oncol 2023; 24 (5): 468–482. doi: 10.1016/S1470-2045 (23) 00147-X.

11. Monk BJ, Toita T, Wu X et al. Durvalumab versus placebo with chemoradiotherapy for locally advanced cervical cancer (CALLA): a randomised, double-blind, phase 3 trial. Lancet Oncol 2023; 24 (12): 1334–1348. doi: 10.1016/S1470-2045 (23) 00479-5.

12. Leath CA, Deng W, Mell LK et al. Incorporation of triapine (T) with cisplatin chemoradiation (CRT) for locally advanced cervical and vaginal cancer: results from NRG-GY006, a phase III randomized trial. Gynecol Oncol 2025; 195: 122–133. doi: 10.1016/j.ygyno.2025. 03.007.

13. Neoadjuvant Chemotherapy for Locally Advanced Cervical Cancer Meta-analysis Collaboration. Neoadjuvant chemotherapy for locally advanced cervical cancer: a systematic review and meta-analysis of individual patient data from 21 randomised trials. Eur J Cancer 2003; 39 (17): 2470–2486. doi: 10.1016/s0959-8049 (03) 00425-8.

14. da Costa SCS, Bonadio RC, Gabrielli FCG et al. Neoadjuvant chemotherapy with cisplatin and gemcitabine followed by chemoradiation versus chemoradiation for locally advanced cervical cancer: a randomized phase II trial. J Clin Oncol 2019; 37 (33): 3124–3131. doi: 10.1200/JCO.19.00674.

15. Lorusso D, Xiang Y, Hasegawa K et al. Pembrolizumab or placebo with chemoradiotherapy followed by pembrolizumab or placebo for newly diagnosed, high-risk, locally advanced cervical cancer (ENGOT-cx11/GOG-3047/KEYNOTE-A18): a randomised, double-blind, phase 3 clinical trial. Lancet 2024; 403 (10434): 1341–1350. doi: 10.1016/S0140-6736 (24) 00317-9.

16. McCormack M, Eminowicz G, Gallardo D et al. Induction chemotherapy followed by standard chemoradiotherapy versus standard chemoradiotherapy alone in patients with locally advanced cervical cancer (GCIG INTERLACE): an international, multicentre, randomised phase 3 trial. Lancet 2024; 404 (10462): 1525–1535. doi: 10.1016/S0140-6736 (24) 01438-7.

17. ESMO. A short-course of induction chemotherapy followed by chemoradiotherapy significantly improves survival in patients with locally advanced cervical cancer. [online]. Dostupné z: https: //www.esmo.org/ oncology-news/a-short-course-of-induction-chemotherapy-followed-by-chemoradiotherapy-significantly-improves-survival-in-patients-with-locally-advanced-cervical-cancer.

18. Colombo N, Dubot C, Lorusso D et al. Pembrolizumab for persistent, recurrent, or metastatic cervical cancer. N Engl J Med 2021; 385 (20): 1856–1867. doi: 10.1056/NEJMoa2112435.

19. Lorusso D, Colombo N, Dubot C et al. Pembrolizumab plus chemotherapy for advanced and recurrent cervical cancer: final analysis according to bevacizumab use in the randomized KEYNOTE-826 study. Ann Oncol 2025; 36 (1): 65–75. doi: 10.1016/j.annonc.2024. 10.002.

20. Marabelle A, Le DT, Ascierto PA et al. Efficacy of pembrolizumab in patients with noncolorectal high microsatellite instability/mismatch repair-deficient cancer: results from the phase II KEYNOTE-158 study. J Clin Oncol 2020; 38 (1): 1–10. doi: 10.1200/JCO.19.02105.

21. Oaknin A, Monk BJ, de Melo AC et al. Cemiplimab in recurrent cervical cancer: final analysis of overall survival in the phase III EMPOWER-Cervical 1/GOG-3016/ENGOT-cx9 trial. Eur J Cancer 2025; 216: 115146. doi: 10.1016/j.ejca.2024.115146.