Management of Recurrent and Metastatic Cervical Cancer: A Review of Current Practice

Cervical cancer continues to have a global impact, with an annual incidence of 600,000 cases and mortality between 300,000–350,000. Despite improved outcomes for early-stage and locally advanced disease, and decades of treatment advancements, the 5-year overall survival for recurrent or metastatic cervical cancer (RMCC) remains below 20%. This review aims to examine advances in RMCC management, current evidence, and novel research that could change future management. Platinum-based chemotherapy combined with paclitaxel continues to have strong evidence as the backbone of first-line management. The integration of bevacizumab further prolonged survival, and the advent of immunotherapy has proved groundbreaking for RMCC prognosis. Specifically, pembrolizumab or atezolizumab may prolong survival by up to a year when added to first-line management. However, second- and third-line management of RMCC remains suboptimal. Antibody–drug conjugates, such as tisotumab vedotin, have demonstrated the most prolonged overall and progression-free survival in this setting. Future breakthroughs appear imminent in the fields of combined immunotherapy and adoptive cell therapy, with Phase I and II trial evidence suggesting promising response rates and improved overall survival, along with well-tolerated toxicity. The recent innovations in RMCC management trend towards an increasingly individualized approach. Continued investment is crucial to better understand a disease that maintains abysmal outcomes in the recurrent or metastatic setting, and remains suboptimally managed on a global scale. Fortunately, groundbreaking trials, such as KEYNOTE-826, BEATcc, and innovaTV 301, have established improved outcomes through immunotherapy and antibody–drug conjugates as standards of care in RMCC management, and continue to guide future research endeavors.