Doi: 10.1200/JCO.18.01265Ĥ 4 Huh WK, Brady WE, Fracasso PM, Dizon DS, Powell MA, Monk BJ, et al. Efficacy and safety of pembrolizumab in previously treated advanced cervical cancer: results from the Phase II KEYNOTE-158 Study. 1 1 Chung HC, Ros W, Delord JP, Perets R, Italiano A, Shapira-Frommer R, et al. Examples include vaccines (bioengineered modified listeria monocytogenes, Axalimogene filolisbac), anti-PD1 monotherapy (nivolumab, pembrolizumab, balsilimab) or combined with anti-cytotoxic T lymphocyte-associated protein 4 (anti-CTLA4), such as nivolumab plus ipilimumab and balstimab plus zalifrelimab. Important advances have been shown in the last decade with immunotherapy leveraging the 30% 12-month survival limit seen in historical studies by the GOG. This combination compares favorably to each drug alone and highlights the exciting moment in cervical cancer research. Camrelizumab plus apatinib in patients with advanced cervical cancer (CLAP): a multicenter, open-label, single-arm, Phase II trial. 3 3 Lan C, Shen J,Wang Y, Li J, Liu Z, He Mian, et al. Of note, the median duration of the response and the median overall survival were not reached yet. This heavily pretreated population (57.8% received ≥ 2 lines of chemotherapy) showed RRs of 55.6%, and 12-month survival ∼ 60%. Recently published in the Journal of Clinical Oncology the impressive results of camrelizumab, an antiprogrammed cell death-1 antibody (anti-PD1), plus apatinib, a tyrosine kinase inhibitor against vascular endothelial growth factor receptor-2 (anti-VEGFR-2) in 45 patients with advanced cervical cancer who progressed after at least 1 line of systemic therapy. Doi: 10.1007/s1191-zīased on these findings, the 12-month survival has never increased beyond 30%, with RRs < 15%. Gynecologic oncology group trials of chemotherapy for metastatic and recurrent cervical cancer. Over the past 3 decades, the GOG has studied many chemotherapeutic agents and has shown that the 12-month survival, RRs, and duration of response are low with chemotherapy alone. More recently, pembrolizumab received Food and Drug Administration (FDA) approval as second-line therapy based on durable responses for patients with cervical cancer who expressed a combined positive score of > 1%, although the response rate (RR) in this scenario was still poor (14%). The association of human papillomavirus (HPV) infection and immunosuppression with an increased risk of cervical cancer led to the hypothesis that the immune system may have an important role in this disease. Regarding the second line, no drug demonstrates a survival benefit and, therefore, no therapy can be considered the gold standard. After the Gynecology Oncology Group (GOG) 240 study, the first-line standard of care for patients in recurrent and/or metastatic settings includes the incorporation of bevacizumab with chemotherapy. Cervical cancer is a public health problem in low- and middle-income countries, where many patients are diagnosed at an advanced stage.
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