Metastatic Cervix Uterine Cancer and Therapeutics Updates: A Case Report and Literature Review

Abstract

Metastatic cervical cancer presents new measures related to the association of biological therapies with conventional treatment that varies according to the presence of biomarkers. Based on a case report, we reviewed therapeutic modalities and updates on the use of concomitant immunobiological and oncological treatments to combat invasive cervical cancer. The use of pembrolizumab is a new option in patients with positive PD-L1 associated with metastatic cervical cancer, having demonstrated a favorable toxicity profile and improved survival. In this case report, we describe a 52-year-old woman diagnosed with metastatic cervical cancer who underwent to chemotherapy (CT) with paclitaxel and carboplatin, as well as immunotherapy with pembrolizumab for PD-L1 positive cervical neoplasm and metastasectomy of hepatic lesions. The patient remains under outpatient care with no signs of active disease.

Keywords

uterine cervical neoplasms - neoplasm metastasis - immunotherapy - neoplasm staging - metastasectomy

Author's Contribution

LGRRP: data collection, conceptualization, study design, data analysis, final approval of manuscript, writing – original draft, provision of study materials or patient. LMC: data collection, conceptualization, study design, data analysis, final approval of manuscript, writing – original draft, provision of study materials or patient. MG: data collection, conceptualization, study design, data analysis, final approval of manuscript, writing – original draft, provision of study materials or patient. EALS: data collection, conceptualization, study design, data analysis, final approval of manuscript, writing – original draft, provision of study materials or patient. JSR: data collection, conceptualization, study design, data analysis, final approval of manuscript, writing – original draft, provision of study materials or patient. LRN: data collection, conceptualization, study, data analysis, final approval of manuscript, writing – original draft, provision of study materials or patient. RSC: data collection, conceptualization, study design, data analysis, final approval of manuscript, writing – original draft, provision of study materials or patient. PRR: data collection, conceptualization, study design, data analysis, final approval of manuscript, writing – original draft, provision of study materials or patient.

Publikationsverlauf

Eingereicht: 23. Juli 2024

Angenommen: 20. September 2024

Artikel online veröffentlicht:
25. März 2025

• References

• 1 Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV. et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999; 189 (01) 12-19
• 2 Volkova LV, Pashov AI, Omelchuk NN. Cervical Carcinoma: Oncobiology and Biomarkers. Int J Mol Sci 2021; 22 (22) 12571
• 3 Yu X, Wang Z, Zhang Z, Liu Y, Huang J. Postoperation of cervical cancer with intestine metastasis: a case report and literature review. World J Surg Oncol 2016; 14 (01) 2
• 4 Li H, Wu X, Cheng X. Advances in diagnosis and treatment of metastatic cervical cancer. J Gynecol Oncol 2016; 27 (04) e43
• 5 Kesic V. Management of cervical cancer. Eur J Surg Oncol 2006; 32 (08) 832-837
• 6 Ota N, Yoshimoto Y, Darwis NDM, Sato H, Ando K, Oike T. et al. High tumor mutational burden predicts worse prognosis for cervical cancer treated with radiotherapy. Jpn J Radiol 2022; 40 (05) 534-541
• 7 Abu-Rustum NR, Yashar CM, Arend R, Barber E, Bradley K, Brooks R. et al. NCCN Guidelines® Insights: Cervical Cancer, Version 1.2024. J Natl Compr Canc Netw 2023; 21 (12) 1224-1233
• 8 Colombo N, Dubot C, Lorusso D, Caceres MV, Hasegawa K, Shapira-Frommer R. et al; KEYNOTE-826 Investigators. Pembrolizumab for Persistent, Recurrent, or Metastatic Cervical Cancer. N Engl J Med 2021; 385 (20) 1856-1867
• 9 Wright JD. Management of recurrent or metastatic cervical cancer. In: UpToDate. 2024. Available from: https://www.uptodate.com/contents/management-of-recurrent-or-metastatic-cervical-cancer
• 10 Chung HH, Jo H, Kang WJ, Kim JW, Park NH, Song YS. et al. Clinical impact of integrated PET/CT on the management of suspected cervical cancer recurrence. Gynecol Oncol 2007; 104 (03) 529-534
• 11 Pallardy A, Bodet-Milin C, Oudoux A, Campion L, Bourbouloux E, Sagan C. et al. Clinical and survival impact of FDG PET in patients with suspicion of recurrent cervical carcinoma. Eur J Nucl Med Mol Imaging 2010; 37 (07) 1270-1278
• 12 Friedlander M, Grogan M. U.S. Preventative Services Task Force. Guidelines for the treatment of recurrent and metastatic cervical cancer. Oncologist 2002; 7 (04) 342-347
• 13 Gadducci A, Tana R, Cosio S, Cionini L. Treatment options in recurrent cervical cancer (Review). Oncol Lett 2010; 1 (01) 3-11
• 14 Oaknin A, Gladieff L, Martínez-García J, Villacampa G, Takekuma M, De Giorgi U. et al; ENGOT-Cx10–GEICO 68-C–JGOG1084–GOG-3030 Investigators. Atezolizumab plus bevacizumab and chemotherapy for metastatic, persistent, or recurrent cervical cancer (BEATcc): a randomised, open-label, phase 3 trial. Lancet 2024; 403 (10421): 31-43
• 15 Lorusso D, Xiang Y, Hasegawa K, Scambia G, Leiva M, Ramos-Elias P. et al; ENGOT-cx11/GOG-3047/KEYNOTE-A18 investigators Pembrolizumab plus chemoradiotherapy for high-risk locally advanced cervical cancer: A randomized, double-blind, phase III, ENGOT-cx11/GOG-3047/KEYNOTE-A18 study. Ann Oncol 2023; 34 (Suppl. 02) S1279-S1280
• 16 Monk BJ, Colombo N, Tewari KS, Dubot C, Caceres MV, Hasegawa K. et al. First-Line Pembrolizumab + Chemotherapy Versus Placebo + Chemotherapy for Persistent, Recurrent, or Metastatic Cervical Cancer: Final Overall Survival Results of KEYNOTE-826. J Clin Oncol 2023; Dec 41 (36) 5505-5511
• 17 Coleman RL, Lorusso D, Gennigens C, González-Martín A, Randall L, Cibula D. et al; innovaTV 204/GOG-3023/ENGOT-cx6 Collaborators. Efficacy and safety of tisotumab vedotin in previously treated recurrent or metastatic cervical cancer (innovaTV 204/GOG-3023/ENGOT-cx6): a multicentre, open-label, single-arm, phase 2 study. Lancet Oncol 2021; 22 (05) 609-619
• 18 Pais-Costa S, Lupinacci R. Hepatectomia direita para metástase de carcinoma de colo do útero: relato de caso. [Right hepatectomy from uterine cervical cancer metastasis: a case report]. GED - Gastrenterologia Endoscopia Digestiva 2008; 1: 400-1234
• 19 National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Cervical Cancer. Version 3.2024. Fort Washington: NCCN; 2024. Available from: < https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf >
• 20 Costa SRP, Horta SH, Henriques AC, Waisberg J, Speranzini MB. et al. Hepatectomia para o tratamento de metástases colorretais e não-colorretais: análise comparativa em 30 casos operados. Rev Bras Coloproctol 2009; 29 (02) 216-225 . Available from: https://doi.org/10.1590/S0101-98802009000200009
• 21 Bacalbasa N, Balescu I, Dima S, Popescu I. Hepatic Resection for Liver Metastases from Cervical Cancer Is Safe and May Have Survival Benefit. Anticancer Res 2016; 36 (06) 3023-3027 https://ar.iiarjournals.org/content/36/6/3023#ref-6
• 22 Salib MY, Russell JHB, Stewart VR, Sudderuddin SA, Barwick TD, Rockall AG. et al. 2018 FIGO Staging Classification for Cervical Cancer: Added Benefits of Imaging. Radiographics 2020; 40 (06) 1807-1822