New treatments, clinical trials at Hollings offer hope to cervical cancer patients

January 10, 2022
January is National Cervical Cancer Awareness Month. Adobe Stock image

It’s a new era for cervical cancer treatment.

That’s the message Brian Orr, M.D., an MUSC Hollings Cancer Center gynecologic oncologist and researcher, spreads to patients and fellow doctors, especially as a new year kicks off. January is National Cervical Cancer Awareness Month, and Orr is encouraged about the progress being made in treating cervical cancer.

Over the last few decades there had been very few advances in new treatment options for cervical cancer – but now, this is an area of rapid change. “For the past couple of years, it seems like at every national meeting I attend, there is a new cervical cancer treatment that has promising potential in improving patient care and outcome,” Orr said. “With so many new treatments and clinical trials ongoing, it’s important to come to a place like Hollings where we can provide patients access to these cutting-edge therapies and trials.”

The first major change to treatment in cervical cancer was the incorporation of immunotherapy in 2018 and 2019. “The response to immunotherapy is different than chemotherapy,” he said. “It can be quite dramatic and long-lasting when patients respond well.”

Though these early immunotherapy studies provided hope for some patients, only around 13% of patients had responses. “The challenge we now face is how can we convert the majority of patients to also have good responses?”

One avenue that has yielded positive results in patients is the combining of immunotherapy with existing chemotherapy regiments. In October of 2021, the highly anticipated KEYNOTE-826 trial confirmed that there was a survival benefit of adding immunotherapy in the form of a drug called Pembrolizumab to chemotherapy for patients with persistent, recurrent or metastatic cancer. The discovery completely changed how doctors could initially treat these patients. Orr said that while the findings are encouraging, they don’t necessarily apply to the subset of cervical cancer patients who are diagnosed with early-stage disease who don’t require chemotherapy.

That is one of the reasons Hollings is enrolling patients in an ongoing trial that seeks to answer the question of whether adding immunotherapy to the radiation also improves outcomes for patients. “A significant number of patients who need radiation but not chemotherapy fall into this treatment scenario,” Orr said. “We are excited to offer this trial to our patients, given the recent success of immunotherapy for patients with advanced cervical cancer.”

Dr. Brian Orr will help lead upcoming cervical cancer clinical trials at MUSC Hollings Cancer Center. 
Dr. Brian Orr

Orr said new research is also providing hope to cervical cancer patients who have a recurrence after chemotherapy. Recently, research published in the Journal of Clinical Oncology described the benefits found in combining the dual checkpoint immunotherapy drugs balstilimab and zalifrelimab for patients with recurrent or metastatic cancer who progressed after chemotherapy. “This provides yet another advancement that will be an option for patients who did not get immunotherapy with their initial chemotherapy.”

Orr said advancements have also been made in targeted therapies for cervical cancer. In the fall of 2021, the FDA approved a more targeted treatment approach using a drug called tisotumab in adults with recurring or metastatic cervical cancer who are on, or completed, chemotherapy treatments. Since being approved by the FDA in September, two patients at Hollings have received treatment using tisotumab.

“Tisotumab, otherwise known as Tivdak, is an antibody drug conjugant that targets specific proteins on the surface of cervical cancer cells,” Orr said. “Put simply, the drug targets the receptor on the cell, and once that drug binds, the drug is taken into the tumor cell where it will release toxic particles, killing it. It is a very targeted therapy that is a new approach to cervical cancer that only kills the cancerous cells while leaving healthy cells around it alone.”

Orr said results of clinical trials testing immunotherapies and targeted therapies to treat cervical cancer are extremely promising and will likely result in a new wave of treatments being approved in the coming years. As a part of this wave of new clinical trials, Orr said Hollings will begin enrolling patients in several new promising trials in the coming months.

He also explained that advancements in research and treatment don’t negate the benefit of the already approved human papillomavirus (HPV) vaccine. “The HPV vaccine is one of the best plans we have to prevent a number of cancers, not just cervical cancer but also other types, including head and neck cancer; cancer of the vagina, vulva and penis; esophageal cancer; and anal cancer.”

As the only National Cancer Institute-designated cancer center in South Carolina, Hollings is on a mission to improve HPV vaccination rates around the state. In 2021, Hollings launched its new mini-mobile HPV vaccination van that travels to rural and medically underserved communities to provide the HPV vaccine.

Orr said cervical cancer is the only form of HPV-related cancer that has an available prevention screening. Pap smears are used to detect precancer and early cancer, making the prevention of the other HPV-related cancers that much more important.

“Even the existing screening for cervical cancer isn’t perfect. It is rare, but I still see young women with advanced cervical cancer who have seemingly done everything right and went to their doctors for routine screening. That is why I think it is so important to get the HPV vaccine to bring that risk of cancer as close to zero as possible.”

Orr said it is also important for women to pay attention to their bodies and seek medical attention for anything they may be worried about. Symptoms of cervical cancer to be aware of include abnormal bleeding, bleeding after intercourse, changes in discharge and pelvic pain. “The big takeaway is to pay attention to new or different changes in your health. It’s better to be certain than to ignore signals your body is trying to send to you.”