Advances are reshaping the treatment landscape for cervical cancer -- one of the top three gynecologic cancers in Korea -- as screening programs and HPV vaccination have reduced incidence.
Treatment paradigms are shifting for cervical cancer, one of the top three gynecologic cancers in Korea. In early-stage disease, surgeons are minimizing resection to reduce complications, while in recurrent or metastatic cases, immunotherapies and ADCs are increasingly being adopted. (Credit: Getty Images)
For early-stage disease amenable to surgery, clinicians are increasingly minimizing the extent of resection to reduce postoperative morbidity. Meanwhile, in recurrent or metastatic settings, the adoption of immune checkpoint inhibitors and antibody–drug conjugates (ADCs) has accelerated.
Treatment strategies for cervical cancer remain highly stage-dependent.
According to Professor Kang Ok-ju of the Department of Obstetrics and Gynecology at Asan Medical Center, patients with disease confined to the cervix typically undergo surgery; those with locally advanced disease receive concurrent chemoradiotherapy (CCRT); and those with distant metastases are treated with systemic therapy. However, treatment approaches are evolving across all stages.
Early-stage disease: Less radical surgery for selected patients
For disease limited to the cervix, two main surgical options have traditionally been used: conization and radical hysterectomy. “In very small, early lesions, conization alone may be curative. However, visible lesions often infiltrate surrounding tissue, so radical hysterectomy has been the standard,” Kang said.
Simple hysterectomy and radical hysterectomy (Source: Asan Medical Center YouTube channel)
Recently, simple hysterectomy has emerged as an option for carefully selected patients. Eligibility generally requires all of the following: tumor size ≤2 cm; histology of squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma; no lymph node metastasis; stromal invasion depth <10 mm; <50 percent cervical stromal invasion; no lymphovascular space invasion; and no distant metastasis on preoperative imaging.
“When these criteria are met, outcomes with simple hysterectomy are not inferior, so we consider it for very early-stage patients after thorough evaluation,” Kang said. “Because radical hysterectomy can be associated with more complications due to wider resection, we discuss these trade-offs carefully with patients.”
Another evolving technique is sentinel lymph node biopsy. “Extensive lymph node dissection can lead to lymphedema and significant patient burden,” Kang said. “In selected early-stage cases, sentinel node biopsy does not appear to increase recurrence or reduce survival, reflecting a shift in practice.”
Locally advanced disease: Expanding beyond standard CCRT
For locally advanced cervical cancer, the standard first-line treatment remains concurrent chemoradiotherapy. However, research is exploring ways to improve outcomes.
These include administering chemotherapy before or after CCRT, or combining CCRT with immune checkpoint inhibitors such as Keytruda (pembrolizumab). Studies suggest that these approaches may offer modest improvements in prognosis.
“Some patients with locally advanced disease are already receiving immunotherapy alongside chemoradiation in Korea,” Kang said, noting that efforts to improve treatment continue.
Recurrent or metastatic disease: Rapid advances with immunotherapy and ADCs
Recurrent or metastatic cervical cancer is the most rapidly evolving area, with treatment guidelines changing frequently as new data emerge.
Immunotherapies such as Keytruda (pembrolizumab) and Libtayo (cemiplimab) -- though the latter is not yet available in Korea -- have shown efficacy. Among ADCs, Enhertu (trastuzumab deruxtecan) and Tivdak (tisotumab vedotin) have demonstrated effectiveness, although Tivdak has also not yet been introduced locally.
Combination strategies are also under investigation. “Preliminary studies suggest that combining pembrolizumab with tisotumab vedotin may improve efficacy,” Kang said. “Larger clinical trials are expected to further evaluate this approach.”
Kim Kyoung-Won
댓글
0