Advanced Cervical Cancer Treatment Landscape: Clinical Decision-Making and Biomarker Integration

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Advanced cervical cancer treatment has undergone dramatic transformation with multiple new therapeutic options revolutionizing patient care. NCCN guidelines now incorporate pembrolizumab for locally advanced disease with positive lymph nodes (without requiring PD-L1 testing) and quad therapy including pembrolizumab, bevacizumab, and platinum doublet for metastatic disease (requiring PD-L1 testing). Additional options include tisotumab vedotin antibody-drug conjugate therapy and emerging HER2-targeted treatments for appropriate patient subsets.

Biomarker testing strategies vary among experts, with some obtaining comprehensive molecular profiling upfront while others test as needed for specific treatment decisions. HER2 testing and PD-L1 assessment provide crucial information for treatment planning, though the pembrolizumab indication for locally advanced disease doesn’t require PD-L1 positivity. The evolving treatment landscape necessitates upfront molecular characterization to optimize therapy selection and clinical trial eligibility.

KEYNOTE-A18 trial results demonstrate significant survival improvements with pembrolizumab added to standard chemoradiation for locally advanced cervical cancer, though FDA labeling creates challenges in patient selection. The current staging system limitations, particularly regarding nodal status versus tumor size, complicate optimal patient identification for pembrolizumab therapy. Ongoing trials like EVOLVE, investigating bispecific antibodies, may address unmet needs in patients who don’t qualify for current pembrolizumab indications, continuing the rapid evolution of cervical cancer treatment options.