Novel Cervical Cancer Treatments in Clinical Trial

The last year has been “incredibly exciting” regarding cervical cancer research, according to Abdulrahman K. Sinno, M.D., interim chief of gynecologic oncology, director of surgical research and education at Sylvester Comprehensive Cancer Center and associate professor of clinical obstetrics, gynecology and reproductive sciences for the University of Miami Miller School of Medicine.

“Cervical cancer is a human papillomavirus-mediated disease, and cellular immunity plays a vital role. It is not surprising that immunotherapy works in this space,” he said. “Survival with immunotherapy has significantly improved and its use has moved to the front line and expanded to both locally advanced and metastatic and recurrent cervical cancer. We are currently conducting multiple unique clinical trials on this disease and hope to continue to contribute to the incremental improvement in survival that we are seeing globally.”

According to the National Cancer Institute (NCI), the five-year relative survival rates for cervical cancer vary significantly based on its stage at diagnosis. When cervical cancer is identified at an early stage, the survival rate is notably high, reaching 91%.

However, if the diagnosis occurs after the cancer has spread to nearby tissues, organs or regional lymph nodes, the five-year relative survival rate drops to 60%. In cases where cervical cancer has advanced to a distant part of the body, the five-year relative survival rate further decreases to 19%.

On average, considering all stages, the five-year relative survival rate for individuals with cervical cancer stands at 67%. These statistics highlight the importance of early detection in improving the chances of survival for those affected by cervical cancer.

More than a decade ago, the survival for patients whose cervical cancer recurred was 12 months, said Dr. Sinno. Today, survival after recurrence is 30 months. Targeted therapy and immunotherapy were game changers.

New Treatments for Cervical Cancer

Clinical trial studies are the reason physicians have more options available today than ever to eliminate cervical cancer, Dr. Sinno stated. As South Florida’s only NCI-designated cancer center, Sylvester has access to the newest therapies and can offer them through clinical trials.

“The standard of care with chemo, biologics and immunotherapy became the standard of care only this year, and we’ve been doing that for eight years at Sylvester,” he said, emphasizing the power of clinical trials.

Screening for human papillomavirus (HPV) and vaccination has also helped reduce cervical cancer cases nationwide. HPV causes 90% of all cervical cancer cases and prophylactic vaccination, available to people ages 9 to 26, offers protection from cervical cancer. Diagnoses of cervical cancer have decreased by 50% since 1975 and researchers agree cervical cancer can be eliminated.

As a World Health Organization partner, Sylvester continuously explores novel ways to eliminate cervical cancer. Beyond immunotherapy, the center is investigating genomic sequencing, therapeutic and prophylactic vaccines, cellular therapy, social determinants of health and the mind-body connection.

Through genomic sequencing, researchers can identify the best therapies. Also, vaccines offer protection from HPV and newer therapeutic vaccines deliver tumor antigens to kickstart the immune response.

Cellular therapy is a new area of study for cervical cancer. Researchers identify cervical cancer-fighting cells, cultivate them in a lab, expand them exponentially and re-insert them in the patient’s body.

In addition to cellular therapy, the use of CAR T-cell therapy is also being studied to treat cervical cancer. One therapeutic vaccine in clinical trial has been combined with immunotherapy to see if the double punch could rev up treatment.

“The antibody drug conjugate tisotumab vedotin-tftv has also gained approval and became a standard-of-care therapy this year. This therapy extends survival significantly,” said Dr. Sinno.

Social Determinants of Health

Beyond cancer survival studies, Sylvester is surveying the social determinants of health—the everyday life challenges that people face—to uncover obstacles to screening, diagnosis and treatment of cervical cancer. Researchers are laying the groundwork for programs to help improve women’s lives through immune-mediated methods and the mind-body connection.

Stress, through the mind-body connection, can affect immune cells, making them less likely to eliminate cancer and leading to potentially worse outcomes. Sylvester is currently analyzing the impact of psychological stress and whether it can be mitigated with lifestyle medicine, such as with diet and exercise, to reduce or help cure cancer, said Dr. Sinno.

“We are actively doing research with marginalized patients in our community,” said Dr. Sinno, who spoke about the rich diversity of South Florida, which allows researchers to work across many groups. “Cervical cancer is cancer that can happen to anyone and especially in those who are underserved, underinsured, racial minorities and in lower socioeconomic demographics.”

Academic Environment Spurs New Cancer Treatments

The collaborative and academic approach to treatment is unique at Sylvester, as patients are treated with novel therapies and work on fitness, nutrition and stress with lifestyle medicine, noted Dr. Sinno.

“You can’t research psychological distress and its effect on cervical cancer outside of a university and academic setting due to the lack of funding for this kind of science. But we do because we’re in academic research, so we’re pushing for this,” he said. “We’re developing a niche in the space and believe this will significantly improve both quantity and quality of life for women with cervical cancer. Sylvester is on the leading edge of science. With all of these therapies combined, we are hopeful that we are going to cure cervical cancer.”

Tags:CAR T cells, Cervical cancer, Dr. Abdulrahman K. Sinno, HPV vaccine, HPV-related cancers, social determinants of health, Sylvester Comprehensive Cancer Center