Abstract
Cervical cancer is one of the most common gynecological tumors, and the majority of early-stage cervical cancer patients achieve good recovery through surgical treatment and concurrent chemoradiotherapy (CCRT). However, for patients with recurrent, persistent, metastatic cervical cancer, effective treatment is rare, except for bevacizumab combined with chemotherapy. Programmed cell death-1/programmed cell death-ligand 1 (PD-1/PD-L1) inhibitors might be a novel choice to improve the clinical outcomes of these patients. Thus far, some pivotal trials, including Keynote 028, Keynote 158 and Checkmate 358, have indicated established clinical benefit of PD-1/PD-L1 inhibitors in cervical cancer. In light of these data, the FDA has approved pembrolizumab for patients with recurrent or metastatic cervical cancer with disease progression during or after chemotherapy. There are also some ongoing studies that may provide more evidence for the PD-1/PD-L1 pathway as a therapeutic target in cervical cancer. In this review, we have summarized the status and application of PD-1/PD-L1 inhibitors in clinical trials for the treatment of cervical cancer and suggested some future directions in this field.
Highlights
Cervical cancer is one of the most common gynecological tumors
In 2014, the GOG 240 trial indicated that when bevacizumab was added to the chemotherapy, the objective response rate (ORR) was improved from 36 to 48% (Tewari et al, 2014), and the overall survival rate (OS) could be prolonged from 13 to 17 months for recurrent, persistent, metastatic cervical cancer, laying the foundation for the first-line choice of combining bevacizumab with chemotherapy for this population (Tewari et al, 2017)
Accumulating evidence has demonstrated that PD-1/PD-L1 inhibitors may be a promising approach for cervical cancer treatment
Summary
Cervical cancer is one of the most common gynecological tumors. More than 569,847 women are diagnosed with cervical cancer annually worldwide, resulting in over 311,365 deaths (Bray et al, 2018). In 2014, the GOG 240 trial indicated that when bevacizumab was added to the chemotherapy, the ORR was improved from 36 to 48% (Tewari et al, 2014), and the OS could be prolonged from 13 to 17 months for recurrent, persistent, metastatic cervical cancer, laying the foundation for the first-line choice of combining bevacizumab with chemotherapy for this population (Tewari et al, 2017) For those who progress during the first-line treatment, the lack of effective second-line treatment remains to be the main reason for the high mortality rate (Minion and Tewari, 2018). Accumulating evidence has demonstrated that PD-1/PD-L1 inhibitors may be a promising approach for cervical cancer treatment
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