Krishnansu Tewari, MD, associate professor, Division of Gynecologic Oncology, University of California, Irvine, discusses the evolution of treatment in cervical cancer.

The most important improvements in the treatment paradigm have been those in supportive care, says Tewari. In the United States, cervical cancer is commonly found in women who do not have access to healthcare and therefore do not have the opportunity to get Pap smears or the HPV vaccine. Therefore, at the time of diagnosis, the disease is often very advanced. These patients’ medical comorbidities are often just as severe.

Physicians have learned that supportive care is just as important as the corresponding therapeutic agent. This was especially true in the trial with bevacizumab (Avastin), notes Tewari. Physicians have made tremendous strides in managing medical comorbidities, correcting malnutrition, and optimizing pain management, states Tewari. Even though these are high-risk patients, they are healthier than they were before, which means that they will be able to better tolerate novel drugs.

Researchers are now limiting the performance status on clinical trials to 0 and 1, whereas in the past patients with an ECOG performance status of 2 could have been enrolled.

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Dr. Tewari on the Evolution of Treatment in Cervical Cancer

Krishnansu Tewari, MD, associate professor, Division of Gynecologic Oncology, University of California, Irvine, discusses the promise of immunotherapy in cervical cancer.

Tewari says that using immunotherapy as a treatment for patients with cervical cancer scientifically makes sense. The mutational burden of cervical cancer is similar to that of other solid tumors that have experienced success with checkpoint inhibitors. Specifically, patients with squamous cell carcinoma of the lung, adenocarcinoma of the lung, head and neck cancer, and cutaneous squamous cell carcinoma (CSCC) have all demonstrated benefit.

The ongoing open-label, multinational, randomized, phase III trial (GOG 3016/ENGOT-cx9) of cemiplimab versus investigator’s choice chemotherapy in previously treated patients with metastatic cervical cancer is aiming to address the impact of immunotherapy in this disease. Cemiplimab has previously shown promise is CSCC, and Tewari is confident that it will have an impact in cervical cancer as well. This PD-1 inhibitor was granted priority review by the FDA in April 2018 for the treatment of patients with metastatic CSCC.

Krishnansu Tewari, MD, associate professor, Division of Gynecologic Oncology, University of California, Irvine, discusses the promise of immunotherapy in cervical cancer.
 

Dr. Tewari on the Promise of Immunotherapy in Cervical Cancer

Krishnansu Tewari, MD, associate professor, Division of Gynecologic Oncology, University of California, Irvine, discusses the GOG 3016/ENGOT-cx9 trial in patients with recurrent or metastatic cervical cancer.

Women with advanced cervical cancer have typically had no options, says Tewari. For thirty years, gynecologic oncologists were not able to make a significant dent in overall survival until they studied bevacizumab (Avastin). These results were reported at the 2013 Annual ASCO Meeting. That led to the regulatory approval of bevacizumab for patients with metastatic and recurrent cervical cancer in approximately 60 countries around the world, states Tewari.

However, there is no option for patients who progress on bevacizumab. There is a lot of interest in immunotherapy, adds Tewari. GOG 3016/ENGOT-cx9 is an open-label, multi-national, randomized, phase III trial of cemiplimab, an anti—PD-1 agent, versus investigator's choice of chemotherapy. The study will accrue approximately 450 patients, and 60 patients have already enrolled on the study.

The trial hopes to help women who have progressed on bevacizumab or who were not good candidates for bevacizumab. These patients are in need of a second-line therapy that is effective and tolerable as chemotherapy alone in the second-line setting is very ineffective.

Krishnansu Tewari, MD

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Dr. Tewari on the Evolution of Treatment in Cervical Cancer

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