Cervical cancer patients have two more treatment options
Cervical cancer is a disease where cancer cells are formed in the tissues of the cervix. Human papilloma virus (HPV) infection is the major risk factor for this common disease which affects females worldwide.
Different types of treatment are available for patients with cervical cancer. For early stages of cervical cancer, treatment like surgery or chemo-radiation therapy helps in a large number of patients. However, for advanced stage or recurrent disease, treatment is mainly done with medicines i.e. chemotherapy.
Conventional chemotherapy medicines are available for advanced or recurrent cervical cancer treatment, which will help control the cancer progression, reduce cancer-related symptoms, improve the quality of life of the patient and also add months or sometimes years of life.
In addition to these, recently, two new options have shown to benefit patients of cervical cancer.
Targeted therapy
> Bevacizumab is a monoclonal antibody that binds to a protein called vascular endothelial growth factor and may prevent the growth of new blood vessels that tumors need to grow. > Bevacizumab is used to treat cervical cancer that has metastasized or has relapsed. > It is generally used in combination with standard chemotherapy and given as IV infusion over few hours in a daycare setting.
Studies show that adding bevacizumab to chemotherapy improved overall survival for women with advanced stage or recurrent cervical cancer. Despite being more specific for tumour cells bevacizumab can have some common and some rare side-effects. Common side effects include nosebleeds, headache, high blood pressure, and rash. Other severe side effects include gastrointestinal perforation, bleeding, allergic reactions and blood clots.
At present bevacizumab treatment is costlier as compared to conventional chemotherapy. Recently cheaper biosimilars to bevacizumab have become available in many countries. Most medical insurance companies support this treatment.
Immunotherapy
Pembrolizumab is a humanised antibody used in cancer immunotherapy. It blocks a protective mechanism of cancer cells, and allows the immune system to destroy the cancer cells. It targets the programmed cell death 1 (PD-1) receptor of lymphocytes.
Research supporting Pembrolizumab in cervical cancer study shows that pembrolizumab is well tolerated and has durable anti-tumour activity in patients with PD-L1-positive advanced cervical cancer.
Current guidelines support the use of Pembrolizumab in second or third line treatment option of metastatic/recurrent cervical cancer with certain genetic anomalies (mismatch repair deficiency or microsatellite instability). It is given as monotherapy by short IV infusion in daycare settings.
Immunotherapy medicines have very specific immune system related side-effect profile. The patient can have infusion-related reactions to pembrolizumab. They can also have rare but severe immune-related adverse effects including inflammation of lung, colon, liver, kidney, brain and endocrine organs. At the moment, treatment is very costly and it may or may not be supported by insurance companies.
In a nutshell, we have two new options in our basket for treating this difficult disease. These medicines can give better control of tumour when used along with conventional chemotherapy or can be used as second/third line treatment options for providing a long and good quality of life to many patients.
Patients should consult their oncologist for further information and discuss the pros and cons of these medicines in their case. Dr Arun Karanwal is specialist in
medical oncology at the International Modern Hospital