Ritu Salani, MD, presents the case of a patient with cervical cancer and describes the typical disease presentation and risk factors.
Case: A 50-Year-Old Woman With Cervical Cancer
Treatment for Recurrence
Ritu Salani, MD: Hello, I’m Ritu Salani. I’m a gynecologic oncologist at UCLA [University of California, Los Angeles] in California. I’d like to welcome you to this Targeted Oncology™ program titled “Case-Based Peer Perspectives: A 50-Year-Old Woman With Cervical Cancer.”
This case is a 50-year-old Black woman who’s busy with family. She’s raising teenage and college-aged kids, works full-time outside the home, and is helping her mother recover from a knee replacement surgery. She reports that her last cervical cytology and HPV [human papillomavirus] testing occurred approximately 6 years ago. Her gynecologist retired 2 years ago, and she hasn’t connected with a new gynecologist. She reports pelvic pain during intercourse and vaginal bleeding following intercourse on her visit.
She undergoes a pelvic MRI, which shows pelvic sidewall involvement including pelvic lymph node–positive disease. She also undergoes a PET [positron emission tomography]–CT scan, which confirms the presence of pelvic disease as well as an isolated liver metastasis. Her diagnosis is consistent with stage IVB adenocarcinoma of the cervix. Immunohistochemistry testing is done on her tumor biopsy, and her tumor is noted to be PD-L1–positive with CPS [combined positive score] greater than 1.
She then undergoes treatment with pembrolizumab, cisplatin, paclitaxel, and bevacizumab as first-line therapy for 6 cycles and transitions to maintenance therapy with pembrolizumab and bevacizumab. After 6 cycles, she’s noted to have a complete response. Although she was advised to continue maintenance therapy, she opts to discontinue treatment. She continues follow-up care, and 11 months later she presents with a cough. An MRI reveals metastatic nodules in her right upper lung, and this is confirmed by biopsy. For treatment, she opts to proceed with tisotumab vedotin.
This is a typical case, although most patients present with early-stage cervical cancer due to screening, which allows for early detection. About 20% of patients with recurrent or advanced disease will present with initial stage IVB disease, as this patient did, so the work-up is critical to make sure we’re catching patients in the right stage of diagnosis. When we think about this case, there are known risk factors for cervical cancer, but not every patient will have known risk factors. A common risk factor for cervical cancer include HPV exposure. This is why HPV is part of the testing for cervical cancer screening, which can increase with multiple sexual partners, high-risk sexual behaviors, or not using barrier contraceptives.
We know that another risk factor can be immunosuppression, and this can be from medications such as transplant medications or diseases such as HIV and AIDS. Other risk factors may include prolonged use of birth control pills and lack of screening, which may fail to detect cancer at early stages.
Transcript edited for clarity.