Liu Zhi-Ping, Liu Si-Han, Zhao He, Ruan Fang-Ying, Zhang Da-Xin, Xu Bai
Department of Oncology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
Department of Medicine, Zhejiang Shaoxing Topgen Biomedical Technology Co. Ltd., Shaoxing City, China.
Case Rep Oncol. 2025 Mar 13;18(1):480-492. doi: 10.1159/000545068. eCollection 2025 Jan-Dec.
Limited treatment options are available for residual locally advanced cervical cancer after concurrent radio-chemotherapy. Pembrolizumab has been approved by the US Food and Drug Administration to treat patients with persistent, recurrent, and metastatic cervical cancer. However, it is expensive and not covered by medical insurance in China.
A patient presented with stage IIIC1 cervical cancer characterized by PTEN, PIK3CA, MTOR, and ARID1A mutations, accompanied by low programmed cell death-ligand 1 expression (tumor cell proportion score 1% and combined positive score 1). The patient exhibited a residual cervical lesion after concurrent radio-chemotherapy but eventually achieved a pathologically complete response through a combination of the programmed cell death-1 (PD-1) inhibitor camrelizumab with the antiangiogenic drug apatinib (two medicines produced by Chinese Jiangsu Hengrui Pharmaceutical Co.). Surgical intervention confirmed the lack of residual tumor cells in the cervix. Regular follow-up confirmed that disease-free survival time was 41 months and overall survival time was 51 months. Adverse events, including cutaneous capillary endothelial proliferation, hepatic insufficiency, hemorrhoidal hemorrhage, and neutropenia, were manageable during treatment with camrelizumab and apatinib.
Our findings suggest that the combination of camrelizumab and apatinib could offer a valuable therapeutic option for residual advanced cervical cancer patients after concurrent radio-chemotherapy. Camrelizumab is affordable, at just 10% of the price of pembrolizumab, although it is similarly not covered by medical insurance for cervical cancer in China. The PTEN, PIK3CA, MTOR, and ARID1A gene mutations hold the potential to serve as predictive biomarkers for cervical cancer patients treated by PD-1 inhibitors.
同步放化疗后残留的局部晚期宫颈癌的治疗选择有限。帕博利珠单抗已被美国食品药品监督管理局批准用于治疗持续性、复发性和转移性宫颈癌患者。然而，其价格昂贵，在中国不在医保报销范围内。
一名患者被诊断为IIIC1期宫颈癌，其特征为存在PTEN、PIK3CA、MTOR和ARID1A基因突变，同时程序性细胞死亡配体1表达水平较低（肿瘤细胞比例评分1%，综合阳性评分1）。该患者在同步放化疗后出现宫颈残留病变，但最终通过程序性细胞死亡蛋白1（PD-1）抑制剂卡瑞利珠单抗与抗血管生成药物阿帕替尼（两种药物均由中国江苏恒瑞医药股份有限公司生产）联合使用实现了病理完全缓解。手术干预证实宫颈无残留肿瘤细胞。定期随访证实无病生存期为41个月，总生存期为51个月。在使用卡瑞利珠单抗和阿帕替尼治疗期间，包括皮肤毛细血管内皮增生、肝功能不全、痔疮出血和中性粒细胞减少在内的不良事件均可控。
我们的研究结果表明，卡瑞利珠单抗和阿帕替尼联合使用可为同步放化疗后残留的晚期宫颈癌患者提供一种有价值的治疗选择。卡瑞利珠单抗价格可承受，仅为帕博利珠单抗价格的10%，尽管在中国它同样不在宫颈癌医保报销范围内。PTEN、PIK3CA、MTOR和ARID1A基因突变有可能作为PD-1抑制剂治疗宫颈癌患者的预测生物标志物。
