PRaG5.0 combined with chemotherapy and sequential chemoimmunotherapy for massive SMARCA4-deficient undifferentiated...

SMARCA4-deficient undifferentiated cervical tumor is highly malignant and responds poorly to conventional treatments, leading to a very poor prognosis. We report a case involving a primary cervical lesion measuring 9.8 cm, managed using a strategy of "PRaG5.0" combined with chemotherapy followed by sequential chemoimmunotherapy. This regimen employs short-course stereotactic body radiotherapy (SBRT, 24Gy/3Fx) as the radiotherapy component, combined with cadonilimab (a PD-1/CTLA-4 bispecific antibody), GM-CSF and thymosin α1 to form the PRaG5.0, alongside chemotherapy with nab-paclitaxel. Following the initial PRaG5.0 with chemotherapy, the patient's symptoms were markedly relieved, and CT images showed the primary lesion had shrunk to 7.2×6.0 cm. Subsequent consolidation with chemoimmunotherapy further reduced the tumor to 3.7×2.9 cm, and the treatment was well-tolerated. The patient's progression-free survival (PFS) now exceeds 12 months. This case indicates that for massive, refractory cervical tumors, PRaG5.0 combined with chemotherapy followed by sequential chemoimmunotherapy may offer an effective approach for controlling disease and extending survival.