Robert L. Coleman, MD, FACOG, FACS, discusses recent advancements made in the cervical cancer space.
Robert L. Coleman, MD, FACOG, FACS, chief scientific officer, The US Oncology Network, discusses recent advancements made in the cervical cancer space.
In the recurrent space, or locally advanced cervical cancer that is not amenable to curative surgery, radiation, or the combination, investigators are channeling their efforts into drug development, says Coleman. One of the most prevalent first advances observed in cervical cancer is that investigators were able to augment the effect of chemotherapy by using antiangiogenesis-based therapies; this research led to an FDA approval. That approach increased not only progression-free survival, but overall survival as well in this patient population; that was a major advance, says Coleman.
Most recently, in 2018, the space saw the FDA approval of pembrolizumab (Keytruda) FDA for use in patients with PD-L1—positive, recurrent cervical cancer. The decision was based on data from the phase 2 KEYNOTE-158 trial, which evaluated pembrolizumab in patients with multiple types of advanced solid tumors who progressed on standard-of-care therapy. At a median follow-up of 10.2 months, the median objective response rate (ORR) was 12.2% (95% CI, 6.5%-20.4%), with 3 complete and 9 partial responses. All 12 responses were in patients with PD-L1–positive tumors, for an ORR of 14.6% (95% CI, 7.8%-24.2%). The median duration of response (DOR) was not reached (range, ≥ 3.7-≥ 18.6 months).
Although the response rates are quite low, the DOR observed in that patient subgroup was actually quite long, notes Coleman. That was a really important advancement in the field. By continuing to examine novel combinations and other modalities, investigators are trying to leverage the immune system even more effectively, concludes Coleman.