In addition, there are many types of anti-PD-1 (such as nivolumab, balstilimab, cemiplimab, etc.) that entered clinical trials of cervical cancer in monotherapy or in combination with other regimes (e.g., targeted therapy, immunotherapy, chemotherapy, and radiotherapy et al.), and the clinical trial results of these anti-PD-1 have published results successively ( 9– 11, 13– 15). Meanwhile, cadonilimab, a PD-1-based bispecific antibody, was also approved for R/M CC in China in 2022 ( 12).

In recent years, the standard treatment for recurrent or metastatic cervical cancer (R/M CC) has been constantly updated, from platinum-based chemotherapy alone to chemotherapy +/- bevacizumab (Bev) based on the GOG-240 trial, and then to chemotherapy + pembrolizumab +/- Bev based on KEYNOTE-028/158/826 trials ( 6, 8– 11).

However, survival decreases markedly for those who relapsed after previous standard treatment and patients diagnosed with metastatic disease (i.e., FIGO stage IVB), with a 5-year survival of only 10% ( 6, 7). Locally advanced CC (LACC) (FIGO 2018 stage IB3, IIA2-IVA) is typically treated with platinum-based concurrent chemoradiotherapy (CCRT), with 5-year survival 50 - 80% ( 3– 5). Early-stage CC (ESCC) (FIGO 2018 stage IA-IB2, IIA1) is usually treated with surgery with 5-year survival > 90% ( 2). For CC patients, different stages have different treatments and different outcomes. This review summarizes ongoing clinical trials and published studies of anti-PD-1 monotherapy and combination therapy in the treatment of cervical cancer, as well as discusses the potential molecular biological mechanisms of combination, aiming to provide the basic evidence for support anti-PD-1 in the treatment of cervical cancer and new insights in combination immunotherapy.Ĭervical cancer (CC), one of the most common malignancies among females worldwide, ranks fourth for both incidence and mortality ( 1). Therefore, understanding the current research progress of anti-PD-1 will better guide clinical application. In addition, anti-PD-1 has also been shown to sensitize radiotherapy. At the same time, the dual specific antibody of PD-1/CTLA-4 was also used in clinical trials of cervical cancer, and the results showed better than anti-PD-1 monotherapy. Therefore, multiple types of anti-PD-1 have entered clinical trials successively and evaluated the efficacy in combination with chemotherapy, targeted therapy, and immunotherapy. Pembrolizumab has been approved for second-line treatment of R/M CC but has a modest overall response rate of about 15%. Anti-PD-1 is currently the most widely used immune checkpoint inhibitor, which has revolutionized cancer therapy for different types of cancer. Although about 90% of early-stage patients can be cured by surgery, advanced-stage patients still need new treatment methods to improve their efficacy, especially for those with recurrence and metastasis tumors.

2National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, ChinaĬervical cancer is one of the three major female gynecological malignancies, becoming a major global health challenge.

1Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Chen Li 1,2 Wei Cang 1,2 Yu Gu 1,2 Lihua Chen 1,2 Yang Xiang 1,2*

Keynote 158 cervical cancer