Ritu Salani, MD, offers clinical insights on the role of biomarker testing in treating cervical cancer.
Case: A 50-Year-Old Woman With Cervical Cancer
Treatment for Recurrence
Ritu Salani, MD: One of the exciting updates in cervical cancer has been the impact of biomarker testing and the ability to provide treatment based on these results. At the time of diagnosis, 1 of the most important biomarker testing results to obtain is the PD-L1 status. This can be done with immunohistochemistry [IHC]. Many patients can do it at their own institutions, but it also can be sent to commercial tumor testing companies for assessment. This will help inform treatment in the advanced-stage and recurrent settings. There are studies ongoing to understand if it has a role in locally advanced disease, but right now it’s more for the advanced and recurrent settings. Because it’s a simple and low-cost test, getting this at the time of diagnosis can be informative. It loses its accuracy if you’re testing an old specimen, so testing at the time of diagnosis may be critical.
This test can be done with IHC and in-house, but there are commercial testing platforms. Other additional testing that can be done and may have an impact include the presence of mismatch repair proteins. This may be most impactful in adenocarcinomas that may be a low-lying endometrial cancer, as well as tumor mutational burden status. Both may inform the role of immunotherapy or checkpoint inhibitors, typically in the recurrent setting. Testing for HPV [human papillomavirus] is becoming more common, and this can also be done in-house or sent out. This may inform future treatments because there are vaccines being developed to target HPV 16 specifically. There’s also T-cell therapy targeting HPV 16, but this is predominantly in the recurrent setting as well. One exciting area of study is HER2 [human epidermal growth factor receptor 2] expression or amplification. This isn’t something that needs to be done at the time of diagnosis, but keep your eye on HER2 expression and cervical cancer because this may continue to play a role.
Transcript edited for clarity.