Therapieoptionen beim metastasierten Zervixkarzinom

The article reports on new international study results with a special focus on new treatment approaches, such as immune checkpoint inhibitors (ICI) and antibody-drug conjugates (ADC).

Since the GOG-240 study in 2014 the combination of platinum/paclitaxel with bevacizumab has been considered the standard of care in the first-line treatment of metastatic/relapsed cervical cancer. Based on the KEYNOTE-826 study, the addition of pembrolizumab to the combination of chemotherapy ± bevacizumab has now been approved for the first-line treatment of recurrent/metastatic cervical cancer positive for programmed cell death protein 1 ligand 1 (PD-L1). The response rates to monochemotherapy as a second-line therapy only range between 0–29% with a progression-free survival (PFS) of 2–5 months and an overall survival of 5–12 months. In 2018 the US Food and Drug Administration (FDA) approved the ICI pembrolizumab as a second-line monotherapy in cervical cancer with PD-L1 expression in the tumor with a combined positive score (CPS)  ≥ 1 based on the KEYNOTE 158 study. Since November 2022 cemiplimab has been approved by the European Medicines Agency (EMA) as monotherapy for the treatment of adults with recurrent or metastatic cervical cancer and disease progression during or after platinum-based chemotherapy based on EMPOWER-Cervical 1/GOG-3016/ENGOT-cx97. For patients without prior first-line therapy with ICI cemiplimab should be the favored second-line therapy. In cases of progression after ICI therapy there have recently been clinically relevant developments, particularly represented by the ADC tisotumab-Vedotin. Based on the innovaTV 204/GOG-3023/ENGOT-cx6 study the substance was approved in the second line by the FDA. In principle, monochemotherapy in second-line therapy is only indicated in individual cases and should be replaced by treatment with an ICI or, in the case of ICI pretherapy, with ADCs.