Cervical Cancer: Treatment

Cervical Cancer: overview

This algorithm covers treatment of cervical cancer across locally advanced, advanced or recurrent, and later-line settings. For locally advanced disease, definitive therapy is cisplatin-based chemoradiation plus brachytherapy, supported by GOG 120, which established concurrent cisplatin as the preferred radiosensitizer. The intensified option adds pembrolizumab to chemoradiation (KEYNOTE-A18), which improved both PFS and OS in high-risk locally advanced disease.

For advanced or recurrent disease in the first-line setting, the chart shows pembrolizumab plus chemotherapy with or without bevacizumab (KEYNOTE-826), the first immunotherapy regimen to improve OS in cervical cancer, with a 7.9-month OS benefit in CPS 1 or higher tumors. Carboplatin and paclitaxel plus bevacizumab is the chemotherapy alternative, supported by GOG-240, in which adding bevacizumab to cisplatin and paclitaxel improved OS, PFS and response rate. In later lines, the options are the tissue factor directed ADC tisotumab vedotin (innovaTV-301), which improved OS versus chemotherapy, and pembrolizumab for PD-L1 positive or MSI-high tumors.

Trials behind this algorithm

• GOG 120 Whitney CW et al, J Clin Oncol, 1999
• KEYNOTE-A18 Lorusso D et al, Lancet, 2024; PMID: 39288779
• KEYNOTE-826 Colombo N et al, NEJM, 2021; PMID: 34534429
• GOG-240 Tewari KS et al, NEJM, 2014; PMID: 24552320
• innovaTV-301 Vergote I et al, NEJM, 2024; PMID: 38959480

Background reading: Cervical cancer board review notes.