Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
Taiwan J Obstet Gynecol. 2024 Sep;63(5):637-650. doi: 10.1016/j.tjog.2024.08.001.
The WHO (World Health Organization) conducted an elimination of cervical cancer program using triple pillar intervention strategy to target 90%-70%-90% of women before the year 2030, including (1) a full vaccination of HPV (human papillomavirus) vaccine to 90% of girls <15 years of age; (2) a high-performance screening procedure to 70% of women during the reproductive age (at the age of 35 and 45 years of age); and (3) an appropriate and adequate treatment to 90% of women with confirmed diagnosis of cervical lesions. Among the aforementioned three pillars, a full HPV vaccination has been introduced in our previous review, of which we have discussed the policy and strategy of HPV vaccination in the world and also reviewed the efficacy of HPV vaccination, with a successful reduction of over 90% of HPV-associated neoplasms. The aims of the current review will target another pillar-an appropriate and adequate treatment to 90% of women with confirmed diagnosis of cervical lesions. Since the early-stage cervical cancer has a favorable outcome and the treatment recommendation has been established, therefore, the current review focuses on women with persistent, recurrent and metastatic cervical cancers (advanced cervical cancers), which are still a biggest challenge based on its extremely worse outcomes before the introduction of immune checkpoint inhibitors (ICIs). Integration of ICIs into conventional chemotherapy (paclitaxel-cisplatin) has become the new standard therapy for those patients with advanced cervical cancers. The recent clinical trials, such as KENOTE 826 and KENOTE A18 showing a dramatical improvement of both progression free survival and overall survival have approved the therapeutic efficacy of this combination as ICI plus paclitaxel-platinum (cisplatin or carboplatin) with/without bevacizumab to women with persistent, recurrent and metastatic cervical cancers.
世界卫生组织（WHO）采用三支柱干预策略开展消除宫颈癌规划，目标是在 2030 年之前实现 90%-70%-90%的目标，包括：（1）对 90%的 15 岁以下女孩进行 HPV（人乳头瘤病毒）疫苗全覆盖接种；（2）对生育年龄（35 岁和 45 岁）的 70%女性进行高效筛查；（3）对确诊为宫颈癌前病变的 90%女性进行适当和充分的治疗。在上述三个支柱中，HPV 疫苗全覆盖接种已在上次综述中介绍，我们讨论了全球 HPV 疫苗的政策和策略，并评估了 HPV 疫苗的效果，成功降低了 90%以上的 HPV 相关肿瘤。本次综述的目的将针对另一个支柱，即对确诊为宫颈癌前病变的 90%女性进行适当和充分的治疗。由于早期宫颈癌的预后良好，治疗建议已经确立，因此本次综述重点关注持续性、复发性和转移性宫颈癌（晚期宫颈癌）患者，在免疫检查点抑制剂（ICIs）引入之前，这些患者的预后仍然极差，这仍然是一个最大的挑战。将 ICIs 与常规化疗（紫杉醇-顺铂）相结合已成为晚期宫颈癌患者的新标准治疗方法。最近的临床试验，如 KENOTE 826 和 KENOTE A18 研究，显示无进展生存期和总生存期均有显著改善，证实了这种联合治疗方案（ICI 联合紫杉醇-铂类[顺铂或卡铂]联合或不联合贝伐单抗）对持续性、复发性和转移性宫颈癌患者的疗效。
