Advancements in Cervical Cancer Management

Borhani stressed that the statistics show an unmet need for developing novel therapeutic strategies to increase durable responses and improve clinical outcomes. Thankfully, she said these new strategies are now emerging.

"In recent years, two new cancer treatment approaches, namely, immunotherapy and targeted therapy, have shown promising results in the laboratory and in clinical trials," Borhani said.

Ruchi Garg, M.D., national program director of Gynecologic Oncology at Cancer Treatment Centers of America, stated that "up until recently, we didn't have any spectacular treatment options for these patients."

She advised that the mainstay of treatment has been chemotherapy and radiation therapy only without much survival advantage in advanced or recurrent disease.

"Now it is such an exciting time with the introduction of immunotherapy, targeted therapies and hopefully soon—therapeutic vaccines," Garg said. "Lots is happening in the world of cervical cancer, which is having an impact on quality of life and survival rates."

The Food and Drug Administration (FDA) has approved several options for the treatment of cervical cancer. Some have only been approved in recent months, making them newly available for women.

Immunotherapy

Borhani said the basic idea of immunotherapy is simple. "The body's immune system has the natural ability to find and destroy cancer cells," she stated. "A family of drugs called 'immune checkpoint inhibitors' can regulate the immune system so that it produces a more robust response to cancer cells."

Immunotherapy treatments include:

• Pembrolizumab (brand name Keytruda) is a checkpoint inhibitor. It works by stimulating the body's immune system to fight cancer cells. There is a protein called PD-1 on the surface of specific immune cells called T-cells. Pembrolizumab targets and blocks this protein which allows the T-cells to identify and kill cancer cells
• Dostarlimab (brand name Jemperli) is also a checkpoint inhibitor that similarly targets the PD-1 protein. The FDA has only approved its use for a specific group of patients with advanced cervical cancer and a DNA mismatch repair deficiency.

Targeted Therapy

Borhani explained that a second approach directly targets certain proteins in the body that play an essential role in tumor progression. An example of such proteins is the Forkhead Box M1 (FOXM1), a known contributor to cancer cell proliferation.

"A recent study by our research group at the University of Illinois published in the journal of Expert Opinion on Therapeutic Targets discusses how inhibiting this protein can lead to the development of new targeted therapies for a range of solid tumors," Borhani said. "This includes gynecologic malignancies and cervical cancer."

Recently approved targeted therapies include:

• Bevacizumab (brand name Avastin) is a monoclonal antibody drug. The National Cancer Institute defines monoclonal antibodies as "a type of protein that is made in the laboratory and can bind to certain targets in the body, such as antigens on the surface of cancer cells." Bevacizumab targets a protein called vascular endothelial growth factor (VEGF) that helps cancers grow blood vessels. By blocking this protein, Bevacizumab stops the cancer from growing. The FDA has approved its use in patients with advanced cervical cancer when combined with chemotherapy.
• Tisotumab vedotin (brand name Tivdak) is a tissue factor-directed antibody approved by the FDA for use in patients with recurrent or metastatic cervical cancer with disease progression on or after chemotherapy. Tisotumab vedotin is the only approved antibody-drug conjugate for this indication and provides a new treatment option for women with recurrent or metastatic cervical cancer.

The landscape for treating cervical cancer has changed in a very short period of time and is advancing at an incredible rate. So much so that the World Health Organization (WHO) has implemented a global strategy to eliminate cervical cancer as a public health problem. They believe the world can achieve this if 90 percent of girls are vaccinated against HPV, 70 percent of women are screened, and 90 percent of women with precancerous or cancerous cervical disease receive treatment.

Several immunotherapies and targeted therapies have recently widened the treatment options for women with cervical cancer, especially those with malignant or advanced disease. However, clinical trials are ongoing with many more therapies.

"It is so satisfying to be able to offer these new treatment options such as Keytruda and Tisotumab vedotin to these patients suffering from cervical cancer," Garg said.

Borhani finished on a very positive note stating that "with the addition of immunotherapy and targeted therapy drugs to our cancer treatment arsenal, we may soon be at a turning point in our fight against cervical cancer."