Case Report: PRaG 3.0 therapy for advanced cervical cancer with severe comorbidities

Patients with advanced cervical cancer complicated by renal dysfunction and severe anemia are frequently ineligible for standard platinum-based chemotherapy, creating an urgent need for effective non-platinum salvage strategies. We report a patient with FIGO stage IVB poorly differentiated cervical squamous cell carcinoma with HER2 immunohistochemistry (IHC) 2+ expression, acute kidney injury caused by malignant ureteral obstruction (serum creatinine, 793 μmol/L), and severe anemia (hemoglobin, 47 g/L) at presentation. After bilateral nephrostomy, the patient received PRaG 3.0, a five-component regimen comprising stereotactic body radiotherapy, adebrelimab (anti-PD-L1), disitamab vedotin (HER2-directed antibody-drug conjugate), granulocyte-macrophage colony-stimulating factor, and interleukin-2. After two cycles, both the cervical primary lesion and pulmonary metastases showed marked regression, and the best overall response was partial response. Treatment was generally manageable; the only grade 3 treatment-related adverse event was an interleukin-2-associated generalized rash, which resolved after drug discontinuation and supportive care. At the last follow-up, progression-free survival exceeded 8 months, and both nephrostomy tubes had been removed. This case suggests that PRaG 3.0 may provide clinically meaningful disease control in selected patients with advanced cervical cancer and severe comorbidities who cannot tolerate platinum-based chemotherapy. Given the single-patient nature of this report, prospective validation is required.