Cervical cancer continues to be one of the most significant global health issues. Despite advances in vaccination against the human papilloma virus (HPV) and early detection screening programmes, this disease still represents the fourth most common cause of cancer in women. Nevertheless, we are currently at a historic juncture, with therapeutic advances that could redefine its management and improve its outcomes.
In recent years, we have witnessed a revolution in the treatment of cervical cancer. Traditionally, the main options included surgery, radiotherapy and platinum-based chemotherapy. Although these treatments continue to be fundamental, the emergence of immunotherapies and targeted therapies have marked a before and after in the fight against this disease.
Advances in surgical and radiotherapy techniques are also transforming the treatment of cervical cancer. Less invasive surgery and sentinel lymph node biopsy are reducing morbidity without compromising oncological outcomes. At the same time, image-guided radiotherapy techniques are allowing for greater precision and fewer side effects.
Immunotherapy in cervical cancer: a paradigm shift
However, one of the most significant advances has been the incorporation of immune checkpoint inhibitors, such as pembrolizumab. Recently approved by the FDA, this drug combined with chemoradiotherapy has provided a significant improvement in survival in patients with locally advanced cervical cancer. This represents a paradigm shift, since for the first time we have a strategy that boosts the immune system to fight the tumour.
Moreover, the INTERLACE trial suggested that induction chemotherapy before chemoradiotherapy is associated with a significant improvement in overall survival, opening the door to new therapeutic strategies. This approach, which aims to reduce the tumour load prior to standard treatment, could become a new standard treatment.
Targeted therapies have also gained prominence. The addition of bevacizumab to chemotherapy has improved the survival of patients with metastatic disease, while antibody-drug conjugates such as tisotumab vedotin have shown promising results in patients with recurrent or refractory disease. These strategies are allowing for increasingly personalized medicine, based on biomarkers and the specific characteristics of the tumour.
The outstanding issue - ensuring access for all women
Despite this progress, there is still a lot of work to be done. Unequal access to new treatments and socioeconomic barriers continue to be significant obstacles in the fight against cervical cancer. The universal implementation of vaccination programmes, systematic screening, and the availability of these new therapies must be global priorities in order to reduce the incidence of this disease and its mortality levels.
We are at the dawn of a new era in the treatment of cervical cancer. Recent advances give us reason for hope, but they also remind us of the importance of continuing to invest in research and public health policies to ensure that no woman is left behind in this revolution.
