Work

Durable complete response with chemo-immuno-radiotherapy for metastatic cervical cancer progressing under immunotherapy: a case series

Year: 2025

Type: article

Abstract: • Successful chemo-immuno-radiotherapy as salvage therapy in progressing metastatic cervical cancer that initially responded to immunotherapy. • Chemo-radiotherapy was able to overcome secondary resistance to immunotherapy. • Chemo-radiotherapy should be discussed when the progression is localized and the patient initially responded to immunotherapy. • Both patients achieved durable and complete response. The prognosis for metastatic cervical cancer has dramatically improved in the past years with the addition of anti-PD1/PD-L1 immunotherapy to standard platinum-based chemotherapy +/-bevacizumab. Here, we aimed to investigate the benefit from combining chemo-immuno-radiotherapy for metastatic cervical cancer patients who had oligo-metastasis progression under maintenance immunotherapy, while the other metastatic sites are in remission. We report a case series of two patients diagnosed with multisite metastatic cervical cancer (including peritoneal carcinomatosis) who, after an initial response to pembrolizumab, presented with pelvic progression while maintaining complete regression of extra-pelvic metastases. Both patients underwent radical pelvic external beam radiotherapy (EBRT) and concomitant chemotherapy with weekly cisplatin +/- brachytherapy, while pursuing immunotherapy with pembrolizumab. The two patients achieved durable complete response after completing this treatment scheme and tolerated it well. Patient 1 is in complete response 30 months after the end of chemo-radiotherapy. Patient 2 is in complete response 24 months after the end of chemo-radiotherapy. This case series suggests that chemo-immuno-radiotherapy with EBRT may represent a salvage treatment for patients who develop secondary loco-regional resistance to immunotherapy, as long as there is remission of the metastatic sites. Given the low response rate to chemotherapy in metastatic cervical cancer patients resistant to pembrolizumab, chemo-radiotherapy while pursuing immunotherapy should be investigated in highly selected patients with oligo-metastasis progression.

Source: Gynecologic Oncology Reports

DOI: 10.1016/j.gore.2025.101967

Authors: Thomas Westerhoff, Nathalie Baudoux, Manuela Undurraga, Patrick Petignat, Intidhar Labidi-Galy, Melpomeni Kountouri

Institutions: University Hospital of Geneva, University of Geneva, Swiss Cancer Center Léman, HFR Freiburg Kantonsspital

Language: English

Topic: Endometrial and Cervical Cancer Treatments

Subfield: Obstetrics and Gynecology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $930