The challenge of improving outcomes in locally advanced cervical cancer

Most patients were treated with newer radiotherapy techniques, including intensity-modulated radiotherapy (627 [87%] of 717 patients) and volume-directed brachytherapy (441 [62%] patients), and although the event rate appears similar in those treated with or without intensity-modulated radiotherapy,...

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Bibliographic Details
Published in:The lancet oncology 2023-12, Vol.24 (12), p.1289-1291
Main Author: Mileshkin, Linda R
Format: Article
Language:English
Subjects:
Brachytherapy
Cancer therapies
Cervical cancer
Chemoradiotherapy
Chemotherapy
Disease
DNA vaccines
Female
Human papillomavirus
Humans
Immunotherapy
Lymph Nodes - pathology
Monoclonal antibodies
Neoplasm Staging
Patients
PD-L1 protein
Pembrolizumab
Radiation therapy
Response rates
Targeted cancer therapy
Tumors
Uterine Cervical Neoplasms - pathology
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Summary:Most patients were treated with newer radiotherapy techniques, including intensity-modulated radiotherapy (627 [87%] of 717 patients) and volume-directed brachytherapy (441 [62%] patients), and although the event rate appears similar in those treated with or without intensity-modulated radiotherapy, it would be useful to know the outcomes in those treated with volume-directed brachytherapy compared with dosing to point A. CALLA suggests an international effort to improve access to high-quality radiotherapy treatment worldwide could have a bigger effect on reducing mortality from cervical cancer than continuing to study the addition of different systemic therapies. A post hoc analysis suggested that patients with tumours having a PD-L1 tumour area positivity score of 20% or greater—who made up half of the trial population—appeared to gain a progression-free survival benefit from the addition of durvalumab with a hazard ratio of 0·62 (95% CI 0·42–0·91). A recent publication studying the treatment of human papillomavirus (HPV)-positive cancer with durvalumab plus a HPV-targeted therapeutic DNA vaccine showed a response rate of only 10% in the cervical cancer cohort (n=10).9 We await the results of Keynote A-18, a very similar trial to CALLA, which is testing the addition of pembrolizumab to standard chemoradiotherapy for cervical cancer and is reported in a press release to be positive.10 CALLA does tell us that immunotherapy can be safely given in this setting.
ISSN:1470-2045
1474-5488
1474-5488
DOI:10.1016/S1470-2045(23)00532-6