Cervical cancer is the third most common female cancer and the most common cause of death from gynecologic cancers worldwide. Each year in the United States, more than 13,000 people are diagnosed with cancer of the cervix and more than 4,000 will die of their disease.
Progress has been slow in the management of cervical cancer but there are some recent advances that offer hope. Over the past 50 years there have really only been three major developments in the management of cervical cancer.
- The development of the Pap smear to facilitate early detection.
- The recognition that a combination of cisplatin chemotherapy and radiation improves outcomes of locally advanced cancer.
- The recognition that human papilloma virus causes cervical cancer, leading to the development of an effective vaccine. Routine HPV vaccination is recommended for both boys and girls age 11-12.
Precision medicine and immune-oncology represent the best hope for the future.
Precision cancer medicine: Unlike traditional chemotherapy, which attacks any cell in the body that is rapidly dividing, precision cancer medicine aims to target specific genetic alterations that allow cancer cells to grow. Most or all cancers result from abnormal genes or gene regulation. The strategy of precision cancer medicine is to define abnormalities at the most basic genetic level. These abnormalities in the DNA are called genomic alterations and they are responsible for driving cancer cell growth. Once the abnormality is identified, genomic tests are created to measure the specific genes in cervical cancer that are abnormal or are not working properly. By identifying the genomic changes and knowing which genes are altered in a patient, cancer drugs that specifically attack that gene (or the later consequences of that gene) can be used to precisely target the cancer and avoid affecting healthy cells.
Immune Checkpoint Inhibitor drugs are currently the most widely used and widely publicized type of immunotherapy treatment. All cells in the body make proteins. Certain types of cancers grow and proliferate by making proteins that inhibit the immune system. These new therapies work by targeting the immune checkpoint proteins that cancer cells use to put a ”brake” on an immune response. By blocking the cancer cells from making these proteins with an immune checkpoint inhibitor, the “brakes” on the immune system are released and the immune system is more effective at killing these cancerous cells. Currently, the FDA approved immune checkpoint inhibitors include drugs that block the checkpoint proteins known as CTLA-4, PD-1 and PD-L1.
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Four new immune checkpoint inhibitors have been approved by the FDA. These include Keytruda (pembrolizumab), Opdivo (nivolumab), Tencentriq (atezolizumab) and Yervoy (ipilimumab) some of which are being evaluated in clinical trials in cervical cancer.
CancerConnect News coverage of advances in the management of cervical cancer included the following key developments in 2016:
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