Efficacy of metronomic chemotherapy in recurrent cervical cancer

Introduction. Cervical cancer (CC) accounts for approximately 2.1% of all new malignant neoplasms and 2.6% of cancer-related deaths among women in Poland. Despite preventive measures, advanced or recurrent CC remains a therapeutic challenge, with median overall survival below 12 months in most cases. Material and methods. We present the case of a 42-year-old woman initially diagnosed with FIGO stage IB1 keratinizing squamous cell carcinoma of the cervix. Laparoscopic radical hysterectomy was performed, and the disease was upstaged to FIGO stage IIIB due to parametrial invasion and lymph node metastasis. Results. As first-line treatment, adjuvant chemoradiotherapy with cisplatin was administered. Despite an initial response, disease progression occurred within one year, with extensive liver and lung metastases. Molecular testing revealed a pathogenic STK11 p.Phe354Leu mutation. Chemotherapy with paclitaxel and cisplatin was initiated but was discontinued because of febrile neutropenia. Further systemic treatment options were limited by cumulative toxicity and the lack of actionable mutations. A metronomic regimen consisting of biweekly gemcit­abine and irinotecan combined with daily oral cyclophosphamide was initiated, leading to radiologic regression of liver lesions, clinical symptom improvement, and disease control for over 12 months, with manageable toxicity and preserved quality of life. Conclusions. Metronomic chemotherapy may represent a valuable therapeutic option in biologically aggressive, treatment-refractory CC. Although understudied in CC, this approach may offer a tolerable and sustained treat­ment strategy in patients with limited systemic options and unfavorable molecular profiles.