Duenas-Gonzalez Alfonso
Departamento de Medicina Genómica y Toxicologia Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autonoma de Mexico/Instituto Nacional de Cancerologia, Mexico City, Mexico.
Expert Opin Pharmacother. 2023 Jan;24(1):73-81. doi: 10.1080/14656566.2022.2084689. Epub 2022 Jun 8.
From a therapeutic standpoint, invasive cervical cancer can be designated as early, locally advanced, and advanced stages. Systemic treatment remains the primary therapeutical modality for advanced cervical cancer patients who are not candidates for local curative treatments (surgery and radiation).
In this review, the author discusses recent clinical studies published in PubMed on the treatment of advanced cervical carcinoma. The author also provides his expert perspectives on the current state of play.
Survival outcomes for advanced cervical cancer patients have been steadily improving since 1981, when single-agent cisplatin was adopted as the standard of care. In 2014, bevacizumab increased median overall survival (MOS) to 17 months when combined with standard chemotherapy (platinum-paclitaxel). In 2021, the checkpoint inhibitor (CPI) pembrolizumab, when used in the first line added to platinum-paclitaxel-bevacizumab, increased mOS to 24 months. Two other CPIs are in phase III trials as first-line treatments. As for second-line therapy, cemiplimab has shown increased survival compared to single-agent chemotherapy, and a phase III trial with tisotumab vedotin is currently ongoing. Nevertheless, there is still an unmet need for new more effective treatments and significant efforts are needed in the discovery of drugs for advanced cervical cancer beyond the current 'me-too' drugs.
从治疗角度来看，浸润性宫颈癌可分为早期、局部晚期和晚期阶段。对于不适合局部根治性治疗（手术和放疗）的晚期宫颈癌患者，全身治疗仍然是主要的治疗方式。
在本综述中，作者讨论了发表于PubMed上关于晚期宫颈癌治疗的近期临床研究。作者还就当前的进展情况提供了他的专业观点。
自1981年单药顺铂被采用作为治疗标准以来，晚期宫颈癌患者的生存结果一直在稳步改善。2014年，贝伐单抗与标准化疗（铂类-紫杉醇）联合使用时，将中位总生存期（MOS）提高到了17个月。2021年，检查点抑制剂（CPI）帕博利珠单抗在一线治疗中与铂类-紫杉醇-贝伐单抗联合使用时，将mOS提高到了24个月。另外两种CPI正在进行一线治疗的III期试验。至于二线治疗，西米普利单抗已显示出比单药化疗更高的生存率，并且一项关于替索单抗维托辛的III期试验目前正在进行中。然而，对于新的更有效的治疗方法仍有未满足的需求，并且在发现超越当前“me-too”药物的晚期宫颈癌药物方面仍需要付出巨大努力。
