Top Line: What is the response rate of neoadjuvant chemoimmunotherapy for locally advanced cervical cancer?
The Study: Concurrent chemoradiation is the standard treatment for locally advanced cervical cancer. The OUTBACK trial found no benefit with adjuvant chemo after CRT, and another randomized phase 2 trial found surprisingly worse outcomes with neoadjuvant chemo prior to CRT. What about immunotherapy? In this small, non-randomized phase 2 trial, 85 patients with PD-L1 positive, locally advanced cervical cancer received induction cisplatin, paclitaxel, and camrelizumab prior to either surgery for responders or chemoradiation for stable disease or nonresponders. They received an initial cycle of cis/paclitaxel and then the same plus camrelizumab for 2 more cycles. Almost all (98%) responded to induction therapy with a complete response in 19% and a partial response in 79%. Most patients (95%) went on to surgery, and among those patients, 39% had a pathologic complete response. A quarter of surgery patients required additional adjuvant therapy (mostly RT or CRT) with the most common indication being lymph node involvement. The response outcomes are encouraging compared to the numbers for chemo alone. However, larger randomized trials are needed to better focus immunotherapy for locally advanced cervical cancer. Could neoadjuvant chemoimmunotherapy improve outcomes for potentially resectable disease without still requiring trimodality therapy? On the other hand, can incorporation of immunotherapy improve outcomes with the mainstay treatment of chemoradiation?
TBL: The majority of patients with PD-L1 positive cervical cancer respond to neoadjuvant chemotherapy and camrelizumab with over a third having a pathologic complete response. | Kezhen, Lancet Oncol 2023
The Study: Concurrent chemoradiation is the standard treatment for locally advanced cervical cancer. The OUTBACK trial found no benefit with adjuvant chemo after CRT, and another randomized phase 2 trial found surprisingly worse outcomes with neoadjuvant chemo prior to CRT. What about immunotherapy? In this small, non-randomized phase 2 trial, 85 patients with PD-L1 positive, locally advanced cervical cancer received induction cisplatin, paclitaxel, and camrelizumab prior to either surgery for responders or chemoradiation for stable disease or nonresponders. They received an initial cycle of cis/paclitaxel and then the same plus camrelizumab for 2 more cycles. Almost all (98%) responded to induction therapy with a complete response in 19% and a partial response in 79%. Most patients (95%) went on to surgery, and among those patients, 39% had a pathologic complete response. A quarter of surgery patients required additional adjuvant therapy (mostly RT or CRT) with the most common indication being lymph node involvement. The response outcomes are encouraging compared to the numbers for chemo alone. However, larger randomized trials are needed to better focus immunotherapy for locally advanced cervical cancer. Could neoadjuvant chemoimmunotherapy improve outcomes for potentially resectable disease without still requiring trimodality therapy? On the other hand, can incorporation of immunotherapy improve outcomes with the mainstay treatment of chemoradiation?
TBL: The majority of patients with PD-L1 positive cervical cancer respond to neoadjuvant chemotherapy and camrelizumab with over a third having a pathologic complete response. | Kezhen, Lancet Oncol 2023