Evidence- and Guideline-Based Treatment for High-Risk Locall

Transcript

Announcer:
Welcome to CE on ReachMD. This activity is provided by Prova Educationand is part of our MinuteCE curriculum.

Prior to beginning the activity, please be sure to review the faculty and commercial support disclosure statements as well as the learning objectives.

Dr. Slomovitz:
Hi. Good day. Now I'm really excited about we have Michelle and Casey back today for our next topic. We're going to talk about newly diagnosed locally advanced cervical carcinoma, or L-A-C-C.

Casey, I get a tissue biopsy from this patient. What are the things you're looking for biologically, translationally, to help us come up with the best treatment options for a newly diagnosed, let's call it a stage II, cervix cancer?

Dr. Cosgrove:
So I try to get together a biomarker-directed panel so that I can provide them the understanding for what treatments are going to be available today, but also give us an idea about what the next steps might be should they need it.

I'm looking at markers for immunotherapy. We have a small percentage of cervical cancers that can have things like mismatch repair deficiency or microsatellite instability. We have some cervical cancers that might have elevated tumor mutational burdens, which also can be a good indicator for immunotherapy.

But perhaps the most important biomarker I'm looking for when I'm sitting across the table for this exact patient is looking at their PD-L1 status to figure out whether or not immunotherapy might be a good fit with our upfront treatment planning.

With that, there's some additional testing I like to get done, because really, time is of the essence sometimes, and it's really nice to be able to have kind of a list of what our treatment plans are going to be looking like now and in the future, so that you're not running backwards and trying to figure things out should they need to have a next line of therapy.

Dr. Slomovitz:
Great. And that's so important that we have these conversations earlier on.

This is a patient with stage II cervical cancer. Imaging reveal that she's actually positive lymph nodes, so she's extremely high-risk locally advanced disease. We've learned to incorporate immunotherapy into our treatments, in addition to radiation and chemotherapy, based on the data from KEYNOTE-A18 which is a study which evaluates pembrolizumab, a checkpoint inhibitor, an immunotherapy, incorporating that into the level of care.

Michelle, I know you’re sort of in the trenches firsthand, having these conversations with me, but then constant communications with the patient; give us a little bit of what your thoughts are on how we approach these patients with KEYNOTE-A18.

NP Michelle Flint:
Thanks, Dr. Slomovitz. So yes, with KEYNOTE-A18, we are seeing these patients in clinic a lot more often because they are on the pembrolizumab for a prolonged period. These patients complete intensive chemoradiotherapy with IO added to it, and then they're continuing on pembrolizumab for roughly 21-22 months in maintenance. It is a long time. But they're happy to come into clinic, to be seeing us, to be surveilling their cancer and to be receiving a maintenance treatment at the same time that's hopefully keeping everything at bay and preventing something from coming back.

Fortunately, they tolerate pembrolizumab very well in general, and they usually have a very good quality of life, so it's not hindering their quality of life. Although IO therapy is not without any complications, we know that pembrolizumab can over-activate the immune system, causing a few different autoimmune conditions. So we do have to stay vigilant to ensure early detection and treatment of these adverse events, because when treated early, we're often able to successfully rechallenge the patient on pembrolizumab and keep them on therapy for a prolonged period.

Dr. Slomovitz:
Thank you so much. We found an overall survival benefit in using this –progression-free survival benefits in using this; things we haven't done in the past.

And Casey, to your point, knowing what's going on molecularly really starts the process to what's going to go on, to help our patients live longer, spend more time with their families, and be disease free.

That's the time we have for locally advanced cancer. Thank you very much. I look forward to our more discussions.

Announcer:
You have been listening to CE on ReachMD. This activity is provided by Prova Educationand is part of our MinuteCE curriculum.

To receive your free CE credit, or to download this activity, go to ReachMD.com/CME. Thank you for listening.

Overview
This series features interdisciplinary discussions on the evolving management of cervical and endometrial cancers, emphasizing biomarker-driven decision-making and personalized care. Experts examine screening, biomarker testing, clinical trial evidence, andthe integration of immunotherapy into guideline-driven treatment regimens, highlighting the clinical implications of PD-L1 expression. Case-based dialogues highlight diagnostic approaches, treatment planning, and toxicity management across disease stages. The program underscores the importance of coordinated care involving oncologists, nurse practitioners, and pathologists to optimize outcomes.
Commercial Support
This activity is supported by an independent educational grant from Merck Sharp & Dohme LLC.
Disclosure of Relevant Financial Relationships
In accordance with the ACCME Standards for Integrity and Independence, it is the policy of Global Learning Collaborative (GLC) that faculty and other individuals who are in the position to control the content of this activity disclose any real or apparent financial relationships relating to the topics of this educational activity. Global Learning Collaborative (GLC) has full policies in place that have identified and mitigated financial relationships and conflicts of interest to ensure independence, objectivity, balance, and scientific accuracy prior to this educational activity.

The following faculty/staff members have reported financial relationships with ineligible companies within the last 24 months.

Faculty:
Brian Slomovitz, MD
Director of Gynecologic Oncology
Co-Chair of the Cancer Research Committee
Mount Sinai Medical Center
Miami Beach, FL

Research support: Aadi, AbbVie, AstraZeneca, Eisai, Genentech, GSK, Merck, Novartis, Pfizer, Sutro, Verastem, Zentalis
Consulting fees: AbbVie, Eisai, Genmab, Gilead, GOG Foundation, Incyte, Merck, Novocure, Pfizer, Regeneron, Repare, Scorpion Therapeutics

Casey Cosgrove, MD
Gynecologic Oncology
Ohio State University
Columbus, OH

Research support: GSK, Regeneron
Royalties: UpToDate
Consulting fees: Astra Zeneca, GSK, Merck Sharp & Dohme LLC

Michelle Flint, WHNP-BC
Nurse Practitioner
Mount Sinai Medical Center
Miami Beach, FL

Consulting fees: Faith, Karyopharm, Verastem

Reviewers/Content Planners/Authors: 
- Tim Person has no relevant relationships to disclose. 
- Jocelyn Timko has no relevant relationships to disclose. 
- Brian P. McDonough, MD, FAAFP has no relevant relationships to disclose.
- Robert Mocharnuk, MD has no relevant relationships to disclose.
Learning Objectives
Upon completion of this activity, learners should be better able to:
- Identify the survival impact of guideline-adherent care for patients with gynecologic malignancies 
- Employ screening and risk stratification strategies to identify patients with and/or at high risk for advanced cervical cancer 
- Apply guideline-concordant testing to the interprofessional and evidence-based treatment of patients with cervical and endometrial malignancies 
- Implement interprofessional team-based strategies for the recognition and management of immune-related adverse events in patients with cervical and endometrial malignancies 
Target Audience
This activity is designed to meet the educational needs of oncologists and pathologists as well as all other physicians, physician assistants, nurse practitioners, nurses, pharmacists, and other members of the interprofessional team who are involved in the management of patients with cervical and endometrial cancers.
Accreditation and Credit Designation Statements
In support of improving patient care, Global Learning Collaborative (GLC) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team. 

Global Learning Collaborative (GLC) designates this MinuteCE activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Global Learning Collaborative (GLC) designates this activity for 1.0 nursing contact hour(s). Nurses should claim only the credit commensurate with the extent of their participation in the activity.
This activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education (IPCE) credit(s) for learning and change.

Global Learning Collaborative (GLC) designates this activity for 1.0 contact hour(s)/0.1 CEUs of pharmacy contact hour(s).

The Universal Activity Number for this program is JA0006235-0000-25-120-H01-P. This learning activity is knowledge-based. Your CE credits will be electronically submitted to the NABP upon successful completion of the activity. Pharmacists with questions can contact NABP customer service (custserv@nabp.net). 

Global Learning Collaborative (GLC) has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit(s) for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credit(s). Approval is valid until October 28, 2026. PAs should claim only the credit commensurate with the extent of their participation in the activity.
Provider(s)/Educational Partner(s)

Prova Education designs and executes continuing education founded on evidence-based medicine, clinical need, gap analysis, learner feedback, and more. Our mission is to serve as an inventive and relevant resource for clinical content and educational interventions across a broad spectrum of specialties. Prova Education's methodology demonstrates a commitment to continuing medical education and the innovative assessment of its effects. Our goal is clear—to develop and deliver the best education in the most impactful manner and to verify its results with progressive outcomes research.
Disclaimer
The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of GLC. This presentation is not intended to define an exclusive course of patient management; the participant should use his/her clinical judgment, knowledge, experience, and diagnostic skills in applying or adopting for professional use any of the information provided herein. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Links to other sites may be provided as additional sources of information.

Reproduction Prohibited Reproduction of this material is not permitted without written permission from the copyright owner. 
System Requirements
- Supported Browsers (2 most recent versions):
- - Google Chrome for Windows, Mac OS, iOS, and Android
  - Apple Safari for Mac OS and iOS
  - Mozilla Firefox for Windows, Mac OS, iOS, and Android
  - Microsoft Edge for Windows
- Recommended Internet Speed: 5Mbps+
Publication Dates
Release Date: 10/31/2025
Expiration Date: 10/31/2026