Robert L. Coleman, MD, FACOG, FACS, reviews the treatment landscape of cervical cancer and identifies recent approvals that have improved patient care.
Robert L. Coleman, MD, FACOG, FACS: Lately, we’ve been in a great situation of being able to talk about advances in cervical cancer management, the greatest of which has probably been a global adoption of vaccination campaigns. While the end results of these efforts probably won’t be realized for decades, the impact of the preinvasive component of this disease is already being observed. In areas where there’s a high vaccination rate and low patient trafficking in and out of a geographical environment, we’re seeing near resolution of high-grade cervical dysplasia. These are the important precursors of the development of cervical cancer. We expect these campaigns to ultimately lead to a reduction in cervical cancer incidence. That’s a tremendous change.
We’re going to talk about treatment. There are a lot of new opportunities in cervical cancer that have come on the coattails of our understanding of how immunotherapy and other agents are behaving with respect to cervical cancer biology. It’s a very exciting time for a disease that we ultimately hope to eradicate because it’s viral induced. For the unfortunate patients that we have to treat, we’re seeing some new opportunities.
We employ 3 treatment modalities that we use for the care of women with the diagnosis of cervical cancer: surgery, chemotherapy, and radiation therapy. Chemotherapy has now been augmented with a new class of drugs that we call biologicals. Those biologicals include factors that involve targeting angiogenesis and factors such as the tumor immune microenvironment. Over the past couple of decades, we’ve seen nuanced use of those modalities. Sometimes all of them are used. But in cases of early-stage disease, surgery alone can be curative, as can radiation therapy alone. In more advanced stages, we start to incorporate chemotherapy and radiation. For patients who have had recurrent disease, sometimes there’s a surgical option. It’s a radical option, but sometimes there’s a surgical option. Then the modalities will be used to address systemic disease, so they can be used in different formats for that particular approach.
Some of the recent advancements have all happened within the last 12 months. We’re very excited to have something to talk about in this particular setting, but they have piggybacked on incremental advances we’ve seen, mostly in the setting of recurrent and metastatic disease, where we have iteratively increased the overall survival expectations by adding drugs to a chemotherapy backbone. Probably the most recent major advance we saw was the addition of bevacizumab to platinum-based chemotherapy in patients with advanced-stage and recurrent cervical cancer.
The crop of trials that we started to see emerge onto the environment looked at the addition of immunotherapy. We initially saw the approval of pembrolizumab, which gained accelerated approval in patients who had PD-L1–positive cervical cancer. Shortly thereafter, earlier this year, we saw the results of a phase 3 trial with another immune checkpoint inhibitor called cemiplimab, which demonstrated improvement in progression-free and overall survival, and objective response over single-agent chemotherapy. That added a second agent to this immunotherapy portfolio. Most recently, we saw the addition of pembrolizumab to the GOG 240 regimen, which was what I just mentioned: the addition of bevacizumab to the chemotherapy backbone in patients with newly diagnosed advanced-stage or recurrent cervix cancer. That also demonstrated an improvement in progression-free and overall survival. That led to our most recent approval of pembrolizumab, not only in that setting but also full approval in the recurrent setting as a single agent. Those were tremendous advances.
Then new to the scene was a cytotoxic agent called tisotumab vedotin, which was studied and demonstrated single-agent activity in patients with recurrent cervical cancer. This led to accelerated approval for that agent. It’s been a fantastic year with so many new options for our patients.
Transcript edited for clarity.