Current Role of Biomarker Testing in Cervical Cancer

EP: 1.Patient Profile: A 50-Year-Old Woman With Cervical Cancer

EP: 2.Cervical Cancer: Classification, Staging, and Prevention

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EP: 3.Current Role of Biomarker Testing in Cervical Cancer

EP: 4.Metastatic Cervical Cancer: First-Line Treatment Options

EP: 5.Second-Line Treatment Options for Recurrent or Metastatic Cervical Cancer

EP: 6.Clinical Pearls and Future Directions of Cervical Cancer Treatment

Case: A 50-Year-Old Woman With Cervical Cancer

Initial Presentation

• 50-year-old, black woman busy with family – teenage/college kids; FT work outside the home; now helping parents as mom is recovering from a knee replacement
• Last cervical cytology and HPV testing – 6 years ago; GYN doctor retired 2 years ago; not connected with new gynecologist.
• Complains of pelvic pain during intercourse, vaginal bleeding post-intercourse
• Pelvic MRI with contrast: involvement of lower vagina, pelvic sidewall, pelvic lymph node positive
• Neck/chest/abdomen/pelvis/groin FDG-PET/CT: liver metastasis
• Clinical Staging: Stage IVB
• IHC molecular testing results: PD-L1 positive, CPS >1
• Received pembrolizumab + cisplatin/paclitaxel + bevacizumab first line for 6 cycles; 6 additional cycles with pembrolizumab + bevacizumab. The patient had a complete response and opted to d/c maintenance treatment.

Follow-Up

• 11 months later the patient presented with complaint of cough.
• MRI: Metastatic nodules in right upper lung confirmed.

Treatment for Recurrence

• Tisotumab vedotin was initiated.

Transcript:

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.