It’s time to eradicate cervical cancer

Analyzing breakthroughs in cervical cancer to help address the unmet need 

In May 2018, the World Health Organization (WHO) announced a global initiative to eliminate cervical cancer as a public health problem,¹ where all countries must reach and maintain an incidence rate of below four per 100,000 women. Cervical cancer is the fourth most common female cancer worldwide and one of the top three cancers to affect women younger than 45,¹ with an estimated 604,000 new cases and 342,000 deaths in 2020.² 

Current treatment options and disease management 

Despite the success of human papillomavirus (HPV) vaccines, existing therapeutic options have low cure rates often with many side effects. Early-stage and locally invasive cervical cancer can be treated with radical hysterectomy or radical trachelectomy with pelvic lymphadenectomy and concurrent chemotherapy and radiation therapy.³ 

A multidisciplinary team can help improve the prevention, screening, treatment and management of cervical cancer. Therefore, it is important for healthcare professionals to identify suspicious and/or precancerous lesions through simple cervical cancer screening, colposcopies and electrosurgical excision procedures for a correct diagnosis and management.⁴  

Currently, chemotherapy remains the basis of treatment; however, it is rarely curative.⁵  Usually, the foundation of systemic therapy consists of cisplatin, either as a single agent or in combination with other agents. First-line cisplatin-based chemotherapy has unacceptable outcomes with response rates of 13% and 36% for cisplatin alone and cisplatin in combination with other agents, respectively.⁵ Recently, double- and triple-agent chemotherapy regimens have progressively been used for patients with recurrent or metastatic disease.   

The availability of targeted therapies and immunotherapy regimens (bevacizumab, pembrolizumab) in combination with, or as alternatives to, existing first- and second-line treatment options has led to improved outcomes in patients with recurrent or metastatic disease.⁶ Bevacizumab in combination with chemotherapy, compared to chemotherapy alone, extended overall survival advantage in 4 months and had a 12% higher response rate.  

Addressing the unmet need 

Unfortunately, for a large proportion of patients with recurrent or metastatic cervical cancer who require treatment beyond first-line therapy, there is no established second-line standard of care, which creates an important unmet need.⁷  

Pembrolizumab was approved in 2018 by the US Food and Drug Administration (FDA) for patients whose tumors express programmed death-ligand 1 (PD-L1), after a modest objective response of 14.3%.⁶  

LN-145, tumor-infiltrating lymphocyte (TIL), was granted breakthrough therapy designation by the FDA in 2019 to treat advanced cervical cancer,⁸ after an objective tumor response of 28%. Two of the responses in cervical cancer were complete and ongoing 67 and 53 months after treatment.⁹ 

Tisotumab vedotin-tftv is the first antibody-drug conjugate for patients with recurrent or metastatic cervical cancer with disease progression on or after chemotherapy and was granted accelerated approval by the FDA in September 2021.¹⁰ Patients on tisotumab had a 24% response rate (95% CI: 15.9%, 33.3%) and a longer duration of response (8.3 months; 95% CI: 4.2, not reached) than other second-line therapies, which adds a further option to the existing second-line armamentarium. 

Emerging therapies 

With new treatments being approved and more in clinical trial stages, it is critical for healthcare professionals to comprehensively understand available and emerging cervical cancer treatments to optimize patient outcomes. As virtually all cases of cervical cancer can be attributed to HPV infection, there’s a need to better understand the molecular biology and tumor-host immune system interaction. Metastatic cervical cancer is not curable, and the hope is that these patients can live for as long as possible.  

As part of the WHO initiative to eliminate cervical cancer as a public health problem, it is critical for healthcare professionals to be continually educated on advances in the field, to keep abreast of the latest data and help inform the most effective treatment pathways in helping eradicate cervical cancer.  

If you would be interested in sponsoring a series of medical education meetings in this therapy arena, contact the Corpus team today for a consultation at communications@the-corpus.com

REFERENCES 

1. Cervical Cancer Elimination Initiative. Available at: https://www.who.int/initiatives/cervical-cancer-elimination-initiative [Accessed 2022 June 28].  
2. Cervical cancer. Available at: https://www.who.int/news-room/fact-sheets/detail/cervical-cancer [Accessed 2022 September 12]. 
3. Ferrall L, et al. Cervical Cancer Immunotherapy: Facts and Hopes. Clin Cancer Res. 2021 Sep 15;27(18):4953-4973.
4. Fowler JR,  et al. Cervical Cancer. [Updated 2022 Apr 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Ferrall L, et al. Cervical Cancer Immunotherapy: Facts and Hopes. Clin Cancer Res. 2021 Sep 15;27(18):4953-4973.  
5. Mauricio D, et al. Immunotherapy in Cervical Cancer. Curr Oncol Rep. 2021 Apr 14;23(6):61.  
6. Abu-Rustum NR, et al. NCCN Guidelines Insights: Cervical Cancer, Version 1.2020. J Natl Compr Canc Netw. 2020 Jun;18(6):660-666.  
7. FDA grants breakthrough therapy designation of new TIL therapy for advanced cervical cancer. Available at: https://ccr.cancer.gov/news/article/fda-grants-breakthrough-therapy-designation-of-new-til-therapy-for-advanced-cervical-cancer [Accessed 2022 September 12]. 
8. Coleman RL, et al; innovaTV 204/GOG-3023/ENGOT-cx6 Collaborators. Efficacy and safety of tisotumab vedotin in previously treated recurrent or metastatic cervical cancer (innovaTV 204/GOG-3023/ENGOT-cx6): a multicentre, open-label, single-arm, phase 2 study. Lancet Oncol. 2021 May;22(5):609-619.   
9. Stevanović S, et al. A Phase II Study of Tumor-infiltrating Lymphocyte Therapy for Human Papillomavirus-associated Epithelial Cancers. Clin Cancer Res. 2019;25(5):1486-1493.  
10. FDA grants accelerated approval to tisotumab vedotin-tftv for recurrent or metastatic cervical cancer. Available at: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-tisotumab-vedotin-tftv-recurrent-or-metastatic-cervical-cancer [Accessed 2022 June 28].