Past present and future of radiosensitization in cervical cancer

Cervical cancer remains a major health concern with over 662,000 cases and 348,000 deaths worldwide yearly. Treatment of early stage disease is generally surgical resection with excellent 5-year survival rates. Locally advanced cervical cancer (LACC) is potentially curable but still has only an approximately 50% 5-year survival rate. LACC is currently treated with chemoradiotherapy (cisplatin). Cisplatin as a radiosensitizer was established by 4 seminal, randomized clinical trials in the 1990s. While radiation techniques have advanced significantly over the past 25 years, the use of cisplatin as a radiosensitizer has not changed. With the development of new, more precise chemotherapy regimens in the form of antibody drug conjugates (ADCs), these drugs would have the ability to improve the therapeutic index of radiotherapy. While ADCs have proven improvement in overall survival and progression free survival in metastatic cervical cancer, they are yet to be studied in the LACC population.] Immune checkpoint inhibitors (ICIs) have also shown improved outcomes in use with metastatic cervical cancer and LACC. We feel that ICIs should be considered as an adjuvant therapy to the more precise ADC radiotherapy to improve tumor control. In summary, multimodal ADC-radio-immunotherapy may benefit patients with LACC and warrants investigation.