Investigational drugs for the treatment of cervical cancer

ABSTRACT

Introduction: Cervical cancer (CC) is currently the fourth most common malignant disease of women worldwide. Although the incidence and the mortality rates have been decreasing with screening detection and new treatment strategies, a significant number of metastatic or recurrent disease is still diagnosed. For those patients not amenable to curative treatments, such as surgery and radiation, palliative chemotherapy remains the standard of care. As chemotherapy regimens have limited activity, research is focalized on investigating novel pharmacologic strategies.

Areas covered: This paper aims to give a complete and updated overview on investigated therapies for the treatment of CC. The authors review the results of clinical studies and highlight the ongoing trials.

Expert opinion: Agents targeting various molecular pathways including epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), mammalian target of rapamycin (mTOR), poly ADP-ribose polymerase (PARP), epigenetics and other biological mechanisms represent interesting investigational opportunities. Amongst such drugs, bevacizumab, an anti-VEGF monoclonal antibody, was the first targeted drug recently approved by the FDA for the treatment of patients with metastatic, recurrent, or persistent CC. Another interesting experimental approach is represented by immunotherapy, which is leading to promising results with to the development of therapeutic vaccines and immune checkpoints inhibitors.

KEYWORDS:

• Angiogenesis inhibitors
• cervical cancer
• immunotherapy
• investigational drugs
• targeted therapy

Article highlights

• The approval of the antiangiogenic Bevacizumab seems to have marked the beginning of a new chapter in the context of CC treatment.

• EGFR inhibitors demonstrated minimal activity in CC treatment, except for erlotinib, which achieved good results in phase II trials.

• mTor and PARP inhibitors seem to be more efficacious in patients with specific genetic mutation. The analysis of the mutational landscapes of the single patient should be integrated in the therapeutic management.

• Epigenetic inhibitors appear to be helpful to convert resistance to chemotherapy in patients with refractory disease.

• Novel molecular pathways, including Notch and Wee, are currently under preliminary investigation, after have showed anti-cancer activity in vitro. Results from their first clinical trials are awaited.

• Immunotherapy, through development of therapeutic vaccines and immune checkpoints inhibitors, represents a promising therapeutic option.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.