Chemoradiation after chemotherapy for metastatic cervical cancer can provide chemo-free time

Stage IVB cervical cancer is treated with a life-prolonging and palliative intent with systemic chemotherapy and immunotherapy. The purpose of this study was to evaluate the number of these patients who had an adequate response to chemotherapy to be eligible for consolidative radiosensitizing chemotherapy and radiation (chemoradiation) and subsequent outcomes.

This is a retrospective review of metastatic cervical cancer patients treated with chemotherapy and evaluated for treatment with consolidative pelvic chemoradiation at a single safety-net hospital system from 2016 to 2024. Demographic data and clinical information were collected from electronic medical records. Stata was used for descriptive statistical analysis.

38 patients met inclusion criteria. Most patients (84%) had squamous cell histology. All patients received platinum-based chemotherapy as first line treatment, some with triplet therapy with immunotherapy (26%) or bevacizumab (42%). Twenty (53%) patients received consolidative chemoradiation. These patients had a median treatment-free interval of 13.7 months (Interquartile range (IQR) 5.3-36.5) after finishing radiation, and 7 (35%) had no evidence of disease at last follow up. Overall survival was 26.7 months (IQR 16.8-55.9). Eighteen patients (47%) progressed on first line chemotherapy and were not eligible for chemoradiation. These patients had a median overall survival of 14 months (IQR 9.1-17.6). Factors at initial presentation associated with progression of disease on first line chemotherapy and ineligibility for chemoradiation prescription for pain medications before treatment (Odds Ratio (OR) 0.17, p=0.059), and prescription for anticoagulation for venous thromboembolism prior to treatments (OR 0.02, p=0.046).

Consolidative pelvic radiation may be considered as a treatment option for select patients with stage IVB cervical cancer. Further research is needed to identify optimal chemoradiation regimens for local disease control, improvements in quality of life and improved health outcomes in the management of metastatic cervical cancer, particularly given the increasing use of pembrolizumab as maintenance therapy.