engleski

What is new in the treatment of recurrent, persistent or metastatic cervical cancer

Cervical cancer accounts for 9% of all new cancer cases per year, with the biggest incidence rate in developing countries. In Croatia in 2014, 307 women were diagnosed with this disease, and 130 of them died. Patients are mostly diagnosed at the age of 50-54 years. The underlying cause of the disease is most often HPV infection and hypoxia. The basis of treatment for recurrent, persistent or metastatic cervical cancer is a systemic antineoplastic therapy. Polychemotherapy was the usuall framework of treatment until the angiogenesis and it’s importance in the process of development of cervical cancer was recognized. By the addition of bevacizumab (study GOG 240), the overall survival and time to progression of the disease were signifi cantly improved, and this treatment is now standard in developed world. Today, there is much talk about immunotherapy and a whole series of clinical studies are performed in the treatment of cervical cancer. The results are relatively modest. One study that should be emphasized is the one using Hinrich’s adaptive immunotherapy model, with which an excellent objective response was achieved, although it included a small number of patients. The use of the checkpoint inhibitor ipilimumab showed a modest partial response in 6% of the patients. In the Keynote 028 study, use of pembrolizumab has led to a response rate of 17%. The concept of the use of the Monocytogenes Monolithic bacterium as HPV antigen vector (Axalimogen fi lolisbac - HPV) is also very interesting and the results of this study (NRG 0265) are very promising (38% of patients survived for one year). To conclude, anti- angiogenic therapy is the fi rst targeted therapy that has shown benefi t in overall survival combined with polychemotherapy, compared to the current standard of polychemotherapy alone. Immunotherapy studies are ongoing and represent new approach in treatment of recurrent, persistent or metastatic cervical cancer.

cervical cancer, metastatic carcinoma, bevacizumab

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