Uterine cervix, how to treat it? Thus the therapy changes for those who discover the tumor already in an advanced stage

Uterine cervix, how to treat it?  Thus the therapy changes for those who discover the tumor already in an advanced stage


Of Vera Martinella

The study that improves survival for locally advanced carcinoma and reduces the risk of disease progression is conceived and coordinated by Italy

In the treatment of advanced cervical cancer, major progress has not been seen for more or less 25 years, but things have finally changed with the arrival of immunotherapy. This was highlighted by the research presented both in June 2023 during the annual conference of theAmerican Society of Clinical Oncology (Asco)both a October 2023 during the congress of the European Society of Medical Oncology. Now comes a new confirmation from one study coordinated by Italy and published in the scientific journal Lancetwhich involved over a thousand women in 30 countries and demonstrates how it is possible improve patient survivaladding immunotherapy to standard therapy (based on chemotherapy and radiotherapy) on the front line.

Cervical cancer

Cervical cancer is the second most frequent gynecological cancer among women, after endometrial cancer, with approximately 2,500 new diagnoses per year in our country. If discovered in the early stages it can be treated successfully, allowing patients to recover completely: pre-cancerous lesions take many years to transform into tumors and, thanks to early diagnosis with Pap test and HPV-DNA testthey can be identified and removed in time, with various strategies available today.
«Cervical cancer is caused in 97% of cases byhuman papillomavirus (HPV) infectionwhich is transmitted sexually – he explains Domenica Lorusso, head of Gynecological Oncology at Humanitas San Pio and full professor at Humanitas University. This cancer can be prevented with HPV vaccination offered free of charge to men and women aged 12 to 26 years and with screening tests with Pap test or HPV-DNA test. The Pap test must be performed every three years starting from the age of 25 (the indications change in case of a positive result); HPV test every 5 years from 30-35 years old”.

Change the standard treatment

In addition to the vaccine and screening checks, which save lives, you need to pay attention to symptoms (common to many diseases of the female genital system) such as abnormal discharge or bleeding not related to the menstrual cycle, pain in the pelvis or back, sudden weight loss.
The results of the KEYNOTE-A18 study published in the Lancet indicate that, in women diagnosed with locally advanced cervical cancer and at high risk of recurrence, theaddition of immunotherapy to standard chemo-radiotherapy treatment offers significant and clinically relevant improvements in survival.
«The trial shows for the first time that adding immunotherapy to chemo-radiotherapy increases overall survival and reduces the risk of tumor progression – continues Lorusso, creator and coordinator of the research while she was responsible for the Clinical Research Programming of the Agostino Gemelli IRCCS University Polyclinic Foundation in Rome -. For the first time in a quarter of a century, we can change the standard of care of one of the most symptomatic and painful neoplasms that can affect a woman. An even more important result because the chemoradio administered is the current standard which in itself already succeeds cure 60% of patients, so on this already very high basis, adding pembrolizumab further helps us cure a greater proportion of patients.”

I study

The KEYNOTE-A18 experimental protocol involved 1060 patients newly diagnosed with high-risk, locally advanced cervical cancerenrolled in 176 centers in 30 countries around the world, between June 2020 and December 2022.
The patients were assigned to two double-blind groups (i.e. without either them or the researchers knowing which group they belonged to): a group of 529 patients who were administered pembrolizumab in addition to chemo-radiotherapy treatment; a control group, with 531 patients, who were given a placebo in addition to the standard treatment. The administration of pembrolizumab (or placebo) occurred both during the chemo-radiotherapy cycles and at the end of the latter, as maintenance treatment.
According to the results of the studyTwo years after treatment, pembrolizumab reduces the risk of disease progression or death by 30%.
The effects of the treatment were seen starting from the first radiographic evaluation and continued over time. For this reason, the researchers believe that the difference between the two groups in terms of efficacy, and therefore the improvement conferred by pembrolizumab, may increase as follow-up continues.
«This is an important milestone, since the conventional treatment, in use since 1999, has limited effectiveness, especially for patients with the locally advanced form of the disease – he concludes Giovanni Scambia, scientific director of Gemelli and head of Gynecology at the University Hospital, who participated in the study –. Previous studies have already shown improvements with the use of pembrolizumab, both alone and in combination with chemotherapy regimens, but only in patients with metastatic or relapsed cervical cancer. This It is the first time we have tested the treatment on the front line, for new diagnoses of locally advanced tumors».

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March 29, 2024 (modified March 29, 2024 | 07:39)

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