Background <p>The second-line treatment for recurrent or metastatic cervical cancer remains uncertain and controversial. Sacituzumab govitecan, the first-in-class antibody-drug conjugate (ADC) targeting trophoblast cell surface antigen 2 (TROP2), has demonstrated promising efficacy and safety in several clinical trials for cervical cancer. However, real-world clinical data on sacituzumab govitecan combined with immunotherapy remains limited.</p> Case presentation <p>A 73-year-old woman diagnosed with stage IIIC1r (FIGO 2018) cervical squamous cell carcinoma underwent concurrent chemoradiotherapy as the primary treatment. The disease recurred 20 months later; thus 3 cycles of chemotherapy combined with bevacizumab and additional 5 cycles of bevacizumab monotherapy were recommended. Although the patient achieved complete response in both the primary treatment and the first recurrence treatment, the second recurrence was detected 15 months later. The patient underwent 6 cycles of sacituzumab govitecan combined with tislelizumab and additional 6 cycles of tislelizumab monotherapy. Partial response was achieved with an 88.1% reduction in target lesion size, along with a PFS of 9 months and an ongoing OS of 13 months.</p> Conclusions <p>Sacituzumab govitecan combined with tislelizumab demonstrated potential treatment response in this case. However, further prospective clinical trials are warranted to validate its efficacy and safety in the difficult second-line setting of recurrent or metastatic cervical cancer.</p>