Published on
Updated
Reading 4 mins.
During the ASCO 2023 cancer congress, two studies on cervical cancer should improve its management both for early forms and for advanced stages. Explanations.
Worldwide, cervical cancer is the fourth most commonly diagnosed cancer and the fourth leading cause of cancer death in women. Prevention of this cancer is based on Pap smear screening and, for some years now, by anti-HPV vaccination.
Radical or simple hysterectomy: is therapeutic de-escalation possible?
In the United States, among people with cervical cancer, 44% are diagnosed with the disease at an early stage, with a significant proportion of so-called “low risk” cancers. When detected at an early stage, the 5-year relative survival rate for invasive cervical cancer is 92%.
The current standard of care for people with early-stage, low-risk cervical cancer is radical hysterectomy. This operation involves the removal of the uterus, cervix, surrounding tissues and ligaments, and part of the vagina.
A Canadian team wanted to know if it was possible to replace this radical hysterectomy with a simple hysterectomy (simple hysterectomy is generally limited to the removal of the uterus and cervix).
The international clinical trial, led by gynecologist oncologist Marie Plante, professor at the Faculty of Medicine at Université Laval and researcher at the CHU de Québec – Université Laval Research Center, recruited 700 patients in 12 countries. These women had cervical cancer discovered at an early stage and deemed low risk. Participants were randomly divided into two groups and subjected to either radical hysterectomy or simple hysterectomy. The pelvic lymph nodes of participants in both groups were examined to ensure that the cancer had not spread.
Same effectiveness, but fewer side effects and better quality of life
After a three-year follow-up, the research team found that the cancer recurrence rate, survival rate, and cancer recurrence-free survival rate (time before the disease came back) were similar in the two groups.
On the other hand, the rate of complications occurring in the first 4 weeks following surgery was 51% in the radical hysterectomy group versus 43% in the simple hysterectomy group. Complications occurring after the fourth week were also more frequent in the first group (61%) than in the second (54%). Simple hysterectomy also produced better outcomes for items associated with quality of life including body image, incontinence and sexual health.
“Our study demonstrates that simple hysterectomy is a safe option for these womencomments Marie Plante. Our findings are likely to influence practice, offering a new standard of treatment more appropriate for patients with low-risk disease.“.
So there is a way to effectively and less aggressively treat cases of cervical cancer discovered at an early stage, while promoting a better quality of life post-treatment. This study should change management practices for these cancers.
In the United States, approximately 16% of people with cervical cancer are diagnosed with metastatic disease. The 5-year relative survival rate for people with metastatic cervical cancer in the United States is 17%. Faced with this particularly formidable cancer, the reference treatment is chemotherapy and bevacizumab (Avastin). But an American team wanted to assess the interest of immunotherapy in this indication.
Pembrolizumab is a type of immunotherapy called a checkpoint inhibitor that works by targeting the protein PD-1 present on the surface of T cells. The molecule PD-1 (programmed cell death) on the surface of T cells binds to another molecule present on the surface of certain tumor cells, PD-L1. This interaction will then deactivate (or disarm) the T lymphocyte. The drugs are then either PD-1 inhibitors (such as pembrolizumab) or PD-L1 inhibitors.
In this study, 617 women with this diagnosis were randomly assigned to receive either pembrolizumab plus chemotherapy or placebo plus chemotherapy, with or without bevacizumab (Avastin). At a median follow-up of 39 months, the combination of pembrolizumab with chemotherapy improved both overall survival and progression-free survival (time to disease progression) in all participants. This progress was observed regardless of whether or not bevacizumab was administered and PD-L1 expression (an indicator predicting the effectiveness of immunotherapy = the higher it is, the greater the effect will be) .
In detail, Overall survival was 28.6 months in the pembrolizumab group versus 16.5 months in the placebo group for those with a combined positive PD-L1 score of 1 or greater, 29.6 months versus 17.4 months for those with a combined positive PD-L1 score of 10 or greater, and 26.4 months versus 16.8 months for all participants. In other words, the combination of pembrolizumab with chemotherapy reduced the risk of death by 40% in patients with a combined positive PD-L1 score of 1 or greater, by 42% in patients with a combined positive score PD-L1 of 10 or more, and 37% in all patients.
Significant adverse events (grade 3 or higher) were more frequent in the pembrolizumab group (82.4% versus 75.4%), mainly anemia (30.3% versus 27.8%), neutropenia (12 .4% versus 9.7%) and hypertension (10.4% versus 11.7%).
The addition of pembrolizumab to chemotherapy with or without bevacizumab in people with persistent, recurrent or metastatic cervical cancer therefore seems to be real progress with several months of life gained. This should change the care of these women.