Durable complete response with chemo-immuno-radiotherapy for metastatic cervical cancer progressing under immunotherapy: a case series.

[OBJECTIVES] The prognosis for metastatic cervical cancer has dramatically improved in the past years with the addition of anti-PD1/PD-L1 immunotherapy to standard platinum-based chemotherapy +/-bevacizumab. Here, we aimed to investigate the benefit from combining chemo-immuno-radiotherapy for metastatic cervical cancer patients who had oligo-metastasis progression under maintenance immunotherapy, while the other metastatic sites are in remission.

[METHODS] We report a case series of two patients diagnosed with multisite metastatic cervical cancer (including peritoneal carcinomatosis) who, after an initial response to pembrolizumab, presented with pelvic progression while maintaining complete regression of extra-pelvic metastases. Both patients underwent radical pelvic external beam radiotherapy (EBRT) and concomitant chemotherapy with weekly cisplatin +/- brachytherapy, while pursuing immunotherapy with pembrolizumab.

[RESULTS] The two patients achieved durable complete response after completing this treatment scheme and tolerated it well. Patient 1 is in complete response 30 months after the end of chemo-radiotherapy. Patient 2 is in complete response 24 months after the end of chemo-radiotherapy.

[CONCLUSIONS] This case series suggests that chemo-immuno-radiotherapy with EBRT may represent a salvage treatment for patients who develop secondary loco-regional resistance to immunotherapy, as long as there is remission of the metastatic sites. Given the low response rate to chemotherapy in metastatic cervical cancer patients resistant to pembrolizumab, chemo-radiotherapy while pursuing immunotherapy should be investigated in highly selected patients with oligo-metastasis progression.