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

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

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

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: 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.