Updates in systemic treatment for metastatic cervical cancer

Cervical cancer has been a leading cause of morbidity and gynecologic cancer deaths throughout the world in this generation despite the implementation of Pap smears. The American Joint Committee on Cancer classifies metastatic cervical cancer as any tumor (T) stage and M1 (distant metastasis of peritoneal spread and involvement of supraclavicular, mediastinal, or para-aortic lymph nodes; lung; liver; or bone) at primary presentation or persistent/recurrent disease outside the pelvis. Radiation with platinum-based chemotherapy is the standard treatment for locally advanced and potentially curable disease at limited metastatic site(s). For patients with recurrent cervical cancer after definitive surgery who have not received prior radiotherapy, salvage chemoradiation is an option. Meanwhile, surgery may be offered to patients with resectable disease if they have received primary radiotherapy. Patients with distant relapse at sole/limited metastatic site(s) could undergo salvage treatment by chemoradiation, surgery plus radiotherapy/chemoradiation, or surgery alone to achieve prolonged survival; hence, they should not be treated with systemic therapy alone. For previously irradiated unresectable lesions or disseminated disease, no effective control of the disease is available; therefore, such patients are candidates for systemic treatment. The primary goal of chemotherapy for those who are not amenable to curative intent is to extend life while offering quality of life. Results of clinical trials using platinum/nonplatinum doublets, molecularly targeted therapies, and immunotherapy, including therapeutic human papillomavirus vaccines, are reviewed.