Treating Locally Advanced Cervical Cancer

The link between human papillomavirus (HPV) and cervical cancer makes immune surveillance and immune therapies viable opportunities in locally advanced disease, states Bradley J. Monk, MD. Studies have explored the use of immunotherapy against HPV in locally advanced and metastatic disease, to augment development of T-cells. Data has also shown activity in cervical cancer when a PARP inhibitor is used in combination with chemotherapy, says Angeles Alvarez Secord, MD.

Chemoradiation is the standard approach in the treatment of locally advanced cervical cancer in the United States, states Robert L. Coleman, MD. In some situations, clinicians may consider the administration of adjuvant chemoradiation; however, stage IIB cervical tumors are not generally chemosensitive, warranting the use of alternate approaches, including neoadjuvant chemotherapy prior to surgery or radiation therapy or neoadjuvant chemoradiation followed by surgery, Coleman explains.

In disease that is too large to resect, cisplatin plus radiation can be administered. Cisplatin is typically given 40 mg/m² (with a 70 mg/m² maximum) weekly for 6 doses in this setting, states Monk. The effectiveness of combination therapies is under investigation, but there is currently no evidence to suggest that combination therapy is superior to single agent cisplatin in combination with radiation.

French trial SENTICOL-2 evaluated intervening with sentinel lymph node biopsy alone versus sentinel lymph node biopsy with pelvic lymph node dissection in individuals with cervical cancer. The primary objective of the study was to compare the surgical morbidity of the two arms. Results demonstrated a decrease in neuropathy, lymphedema, and grade 3 and 4 complications in the arm with sentinel lymph node biopsy alone, notes Secord. It is too early to support that sentinel lymph node biopsy should be performed in all patients who undergo surgical management of cervical cancer, comments Monk.