Dr. Monk on Potential Shifts to Treatment Sequencing Strategies in Cervical Cancer

Bradley J. Monk, MD, FACS, FACOG, professor, Division of Gynecologic Oncology, Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine at St. Joseph’s Hospital, medical director, Gynecologic Program, US Oncology Research Network, and co-director, GOG Partners, discusses potential shifts to treatment sequencing strategies in cervical cancer.

With the resurgence of research with checkpoint inhibitors in cervical cancer, questions regarding treatment sequencing strategies are surfacing, Monk explains. Findings from the phase 3 EMPOWER-Cervical 1 trial (NCT03257267) demonstrated improved survival with cemiplimab-rwlc (Libtayo) vs chemotherapy in patients with recurrent or metastatic cervical carcinoma who progressed on frontline platinum-containing chemotherapy. As such, checkpoint inhibitors may be best utilized as second-line therapy for this patient population, Monk says.

Alternatively, checkpoint inhibitors, such as pembrolizumab (Keytruda), could be sequenced as first-line therapy in combination with chemotherapy with or without bevacizumab (Avastin), Monk says. Then, upon progression, patients could receive the antibody-drug conjugate tisotumab vedotin-tftv (Tivdak), which has wide utility because nearly all patients with cervical cancer express the agent’s target of tissue factor.

Additionally, pembrolizumab and durvalumab (Imfinzi) are being evaluated for frontline use in combination with chemotherapy and radiation therapy, which could elicit improved cure rates in patients with cervical cancer, Monk concludes.