Treatment of cervical cancer: recent achievements and future development

Abstract

Over the last two decades the widespread use of the screening tests, leading to early detection of pre-invasive lesions, has dramatically reduced morbidity and mortality related to cervical cancer (CC), nevertheless CC remains a major health problem, especially in developing countries, where most cases are still diagnosed at late stages. Optimizing treatment is subject of constant research but there are several unanswered questions, including whether radiotherapy is preferred over surgery and which patients should receive neoadjuvant and/or adjuvant chemotherapy. A center’s experience and the accessibility of radiotherapy are often the main factors guiding clinicians’ choices in the approach to locally-advanced disease, which can be treated with different modalities such as chemoradiation and surgery, with or without neoadjuvant and/or adjuvant chemotherapy. Several regimens have been evaluated in the metastatic and recurrent setting, although platinum-based doublets have remained the standard of care for years. Recently, the encouraging results achieved by inhibiting tumor angiogenesis led to the approval of bevacizumab as an addition to conventional chemotherapy. Immunotherapy is another approach that is rapidly gaining credibility in multiple malignancies and several novel agents are under development in the CC population. Although CC has historically been considered ‘chemoresistant’, a number of new approaches to therapy, including angiogenesis blockage and immunotherapy, provide hope for more effective treatment.