Cervical cancer-immunotherapy in locally advanced and metastatic cervical cancer: status quo and new treatment options

Cervical cancer remains the second most common gynecological cancer in women worldwide and is associated with a high mortality rate if diagnosed late. In developed countries, the decline in incidence can be explained primarily by screening examinations (Pap smear, human papillomavirus [HPV] testing), which allow the precancerous and early stages of cervical cancer to be detected in time and treated successfully. Another factor is the implementation of HPV vaccination, which will further reduce incidence and mortality rates in the future. In the early stage, surgical therapy is the mainstay, whereas primary radiochemotherapy is the preferred treatment in advanced-stage disease. The metastatic situation is dominated by chemotherapy in combination with immunotherapy. Immunotherapy is increasingly playing an essential role in gynecological oncology and has also found its way into the treatment of cervical cancer in recent years, especially in the metastatic situation, where treatment options are very limited. Various groundbreaking clinical studies have created new treatment paradigms for persistent, recurrent, and metastatic cervical cancer. Combination of the immune checkpoint inhibitor pembrolizumab with standardized radiochemotherapy also showed positive results for the first time in first-line treatment of locally advanced cervical cancer.