Embracing more treatment choices for metastatic, recurrent, or persistent cervical cancer

• Published in: The Lancet (British edition) Vol. 404; no. 10463; pp. 1618 - 1620
• Main Authors: Sun, Chaoyang, Ma, Ding
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 26.10.2024; Elsevier Limited
• Subjects: Antibodies; Apoptosis; Bevacizumab; Bispecific antibodies; Cancer; Cancer therapies; Cell death; Cervical cancer; Chemotherapy; CTLA-4 protein; Cytotoxicity; Health risks; Immunotherapy; Lymphocytes; Lymphocytes T; Medical prognosis; Metastases; Metastasis; PD-1 protein; PD-L1 protein; Pembrolizumab; Regulatory approval; Risk assessment; Survival; Survival analysis; Tumors
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(24)02196-2

Cervical cancer ranks as the fourth most common cancer among women globally, yet prognosis remains dire for those with recurrent or metastatic disease, evidenced by a mere 19% 5-year survival rate.1 This stark reality underscores the urgent need for novel and enhanced therapeutic options. Since 2014, three landmark phase 3 randomised controlled trials have notably influenced first-line treatment strategies for recurrent or metastatic cervical cancer: GOG-240,2 KEYNOTE-826,3 and BEATcc.4 The GOG-240 trial established the combination of chemotherapy and bevacizumab as the standard first-line intervention for incurable recurrent or metastatic cervical cancer, with a median overall survival of 17 months.2 Subsequently, the KEYNOTE-826 trial showed that adding pembrolizumab to chemotherapy (with or without bevacizumab) markedly improved median overall survival to approximately 26 months.3 Moreover, the BEATcc study evaluated the incorporation of the PD-L1 antibody atezolizumab into first-line chemotherapy combined with bevacizumab, resulting in substantial improvements in overall survival, with a median overall survival of 32·1 months.4 In The Lancet, Xiaohua Wu and colleagues5 present the COMPASSION-16 trial: a phase 3, double-blind, multicentre randomised controlled trial assessing the efficacy of cadonilimab, a bispecific antibody targeting programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte antigen 4 (CTLA-4), in combination with standard chemotherapy with or without bevacizumab as a first-line treatment for persistent, recurrent, or metastatic cervical cancer. Interim analysis revealed that the addition of cadonilimab lowered the risk of disease progression by 38% (hazard ratio [HR] 0·62 [95% CI 0·49–0·80]) and death by 36% (HR 0·64 [0·48–0·86]).