Highlights on Cervical Cancer (ESGO + SGO)

Professor Hannelore Denys, a distinguished medical oncologist at the University Hospital Ghent, offers a comprehensive summary of the pivotal findings on cervical cancer unveiled at the ESGO and the SGO congresses.

The KEYNOTE-A18 phase 3 trial involved over 1000 cervical cancer patients who received either pembrolizumab or placebo alongside standard chemoradiation. Quality of life analysis revealed no significant distinctions between the pembrolizumab and placebo group, indicating that pembrolizumab enhances PFS without adverse effects on quality of life. Additionally, a press release confirmed that the trial successfully achieved its primary endpoint of OS, suggesting potential benefits of pembrolizumab in improving patient outcomes.

The BEATcc trial, conducted in first-line recurrent or metastatic cervical cancer, assesses the efficacy of combining first-line atezolizumab with platinum doublet and bevacizumab. An update of the trial results revealed a notable enhancement in median OS from 20 to 32 months.

SENTIX was a prospective single-arm study conducted internationally across multiple centers, focusing on SLN biopsy without systematic PLND in early-stage cervical cancer patients. Notably, nearly half of the patients with positive lymph nodes in the SENTIX trial were identified through ultrastaging. At ESGO, the initial outcome results were presented, including two years of DFS and OS data, demonstrating favorable outcomes. These findings indicate that the approach utilizing ultrastaging of the sentinel node does not increase the recurrence rate, offering reassurance to our patients.

In conclusion, two intriguing approaches were highlighted at the SGO congress. The first involved a multicenter, open-label, phase I/II study assessing an ADC targeting Nectin-4 in patients with recurrent or metastatic cervical cancer, exhibiting an impressive ORR of 40% and DCR of 89%. Additionally, sacituzumab govitecan, a novel ADC directed to Trop-2, demonstrated promising results with an ORR of 50% and DCR of 94%. These findings offer potential therapeutic avenues for patients in more advanced stages, however, further studies are warranted to validate these outcomes.

Lastly, the NACI study investigating neoadjuvant chemo-immunotherapy in patients with locally advanced cervical cancer revealed a pCR rate of 38% and an impressive ORR of 98%. Furthermore, only 20% of patients required postoperative adjuvant treatment, suggesting a potentially promising approach for managing locally advanced cervical cancer.