Cervical cancer is the third most common gynecologic malignancy in the United States. While it is usually diagnosed in early stages when it can be cured, new therapeutic options are critical for women with advanced cervical cancer.
As South Florida’s only National Cancer Institute (NCI) designated cancer center, Sylvester Comprehensive Cancer Center, part of the University of Miami Health System, offers women a novel investigator-initiated phase 2 clinical trial combining pembrolizumab, chemotherapy, and bevacizumab in patients with recurrent, persistent or metastatic cervical cancer.
Marilyn Huang, M.D., M.S., associate professor of gynecologic oncology and director of translational gynecologic oncology research at Sylvester, is the principal investigator. “Because persistent human papillomavirus (HPV) infection drives cervical cancer, we are investigating combination immune therapy with current standard-of-care chemotherapy treatment,” said Dr. Huang. “Our goal is to enroll 40 women and track their responses to see the impact of this combination strategy on cervical cancer.”
Checkpoint inhibitors target PD-1, a protein on immune system T-cells that normally helps keep these cells from attacking other cells in the body. By blocking PD-1, these drugs boost the immune response against cancer cells. Emerging data suggest that there is synergism between cytotoxic chemotherapy and immunotherapy, with the combination enhancing cell death.
When a woman is diagnosed with early-stage cervical cancer, the first treatment is typically surgery. “But if the cancer has progressed beyond surgery, then radiation treatment, combined with chemotherapy as needed, can deliver good outcomes,” said Lorraine Portelance, M.D., professor and vice chair of radiation oncology at Sylvester
Dr. Portelance and her team use magnetic resonance imaging to identify the size and location of the tumor, so it can be targeted precisely with intensity modulated radiation therapy, proton therapy or brachytherapy. “Our advanced MRI-guided technology lets us focus directly on the tumor, providing better outcomes with less damage to surrounding tissues and a higher quality of life after treatment.”
Dr. Portelance is a fellow of the American Society for Radiation Oncology (ASTRO), which recently issued new radiation guidelines specifically for cervical cancer. ASTRO recommended postoperative radiation therapy for women undergoing surgery with intermediate risk factors, and postoperative chemotherapy and radiation for those with high risk factors. “There is strong evidence supporting the use of radiation therapy with or without chemotherapy in both definitive and postoperative settings,” said the guidelines. “The use of radiation remains an essential component for women with cervical cancer to achieve cure.”
Fortunately, cervical cancers can be prevented by vaccinations that protect against HPV, Dr. Portelance said. Pap tests can detect precancerous changes in the cervix and HPV tests can confirm the presence of high-risk strains.
The U.S. Centers for Disease Control and Prevention recommends that all boys and girls get the HPV vaccine as early as age 11, even before the onset of puberty or sexual activity. The CDC also recommends that women over age 30 have an annual Pap smear screening to detect cellular changes to the cervix caused by HPV.
“Since 2006, millions of women, as well as men, have been vaccinated against HPV,” said Dr. Huang. “It has proven to be remarkably effective in preventing HPV-related cancers and is now approved up to the age of 45. It is readily available through UHealth and other primary care providers throughout our community.”