New Findings on Treatment of Cervical Cancer
- A study published in The New England Journal of Medicine showed that for people with cervical cancer, “Progression-free and overall survival were significantly longer with pembrolizumab.” The study showed a 2-month extension in survival rate for patients treated with pembrolizumab.
- SurvivorNet spoke with leading gynecological oncologists who called this news “exciting,” saying, “there will be a significant improvement in [cervical cancer patients’] longevity” as a result.
- Symptoms of cervical cancer include abnormal vaginal bleeding, unusual vaginal discharge, pain during sex, and pain in the pelvic region.
The study found that patients with persistent, recurrent, or metastatic cervical cancer lived longer when pembrolizumab (brand name: Keytruda), a form of immunotherapy, was added to the standard treatment regimen of chemotherapy.Read More
This is a groundbreaking discovery for people battling cervical cancer, and Dr. Bobbie J. Rimel, an assistant professor of gynecology and obstetrics at Samuel Oschin Comprehensive Cancer Institute, whose area of focus is gynecologic oncology, agrees.
“This study is exciting for sure and means for some patients there will be a significant improvement in their longevity by the addition of pembrolizumab to the three-drug combination we have been using,” Dr. Rimel tells SurvivorNet. The three-drug combination, she says, is, “Carboplatin/taxol/bevacizumab, the regimen standard of care from GOG 240.”
Pembrolizumab is a PD-1 inhibitor given by IV. Other PD-1 inhibitors include Nivolumab (Opdivo) and Cemiplimab (Libtayo). These three drugs have been effective in treating several different types of cancers, says the American Cancer Society (ACS). Some cancers treated by PD-1 inhibitors include non-small cell lung cancer and Merkel cell carcinoma.
Dr. Rimel notes that this treatment is expensive, saying, “This does come at significant cost and that does have to be considered. However, it is very exciting and I’m delighted to see this move forward for our patients.”
About the Study
This study was led by Dr. Nicoletta Colombo of the European Institute of Oncology in Milan, Italy.
In this study, Dr. Colombo looked at the benefit of adding pembrolizumab to chemotherapy with or without bevacizumab. The study was a double-blind, phase 3 trial, reports The New England Journal of Medicine. Dr. Colombo explains the trial in the publication, writing, “we randomly assigned patients with persistent, recurrent, or metastatic cervical cancer in a 1:1 ratio to receive pembrolizumab (200 mg) or placebo every 3 weeks for up to 35 cycles plus platinum-based chemotherapy and, per investigator discretion, bevacizumab.”
For 548 patients in the study, progression-free survival was 10.4 months in the pembrolizumab group. And for participants in the placebo group, progression-free survival was 8.2 months. These figures demonstrate the life-prolonging effect of pembrolizumab by a minimum of 2 months for people with cervical cancer.
The conclusions of the study were as follows: “Progression-free and overall survival were significantly longer with pembrolizumab than with placebo among patients with persistent, recurrent, or metastatic cervical cancer who were also receiving chemotherapy with or without bevacizumab.”
Medical oncology fellow, Dr. Emily Nachtigal, explains to SurvivorNet the impact of these findings, saying, “Using pembrolizumab for cervical cancer is not new, but it is currently only approved for second-line therapy in patients who are PDL1 positive and have progressed on first-line therapy. So if anything, it will change the timing of immunotherapy.”
Dr. Nachtigal says of this treatment’s tolerability, “Generally pembrolizumab is a relatively easy treatment for patients to tolerate.” She says the primary benefit of the 2-month extension “might be in patients who don’t have a lot of time because of aggressive disease.”
She also stresses the importance of the timing of cancer therapy, saying, “Imagine a woman with metastatic cervical cancer; she gets started on carbo/taxol and waits 3 months until she has a scan that shows progression. She then might be switched to pembrolizumab, but immunotherapy takes months to work. It is not uncommon for patients to die before they are able to get to second or third-line therapy. Scenarios like this make the timing of therapy important.”
Understanding Cervical Cancer
Every year in the U.S., approximately 14,480 women will be diagnosed with cervical cancer. And nearly a third of women diagnosed will pass away from this disease.
Getting screened for cervical cancer is critically important because an earlier diagnosis may mean a better prognosis and broader treatment options. Screening for cervical cancer is done via pap smear and HPV DNA testing, which is recommended by the World Health Organization (WHO) as the best screening option for cervical cancer. Cervical cancer treatments may include surgery, radiation, and chemotherapy.
The most common symptoms of cervical cancer can include:
- Abnormal vaginal bleeding, such as bleeding after vaginal sex, bleeding after menopause, bleeding and spotting between periods, or having (menstrual) periods that are longer or heavier than usual. Bleeding after douching may also occur.
- An unusual discharge from the vagina − the discharge may contain some blood and may occur between your periods or after menopause.
- Pain during sex.
- Pain in the pelvic region.
Preventing Cervical Cancer
One way to significantly decrease your risk of developing cervical cancer is to get the HPV vaccine.
In an earlier interview, Dr. Jessica Geiger, a medical oncologist at Cleveland Clinic Cancer Center, explains the importance of the HPV vaccine as prevention against cervical cancer. She says, “We recommend strongly that children are vaccinated against HPV to prevent cervical cancer, but also to prevent head and neck cancer.”
“HPV is spread through sexual contact,” says Dr. Geiger. “Now the key with the vaccine is that you received the vaccine before you ever reach sexual debut or have sexual encounters. So that’s why these vaccines are approved for young children ages 9, 10, 11 years old, up to 26.”
“HPV is a virus that’s actually very well spread throughout Western society,” she says. “Fortunately, for the majority of us, over 90%, we clear the virus without ever knowing that we were exposed.”