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Recurrent or metastatic cervical cancer has spread beyond the pelvis or come back where it cannot be cured by surgery or radiotherapy. Pembrolizumab added to chemotherapy and bevacizumab is the first treatment, and the antibody-drug conjugate tisotumab vedotin or the PD-1 antibody cemiplimab extend life when it progresses.
Persistent disease after chemoradiation, recurrence outside a previously irradiated field and stage IVB disease at presentation are managed together. Isolated central pelvic recurrence after radiotherapy can still be cured by exenteration, and an isolated para-aortic or lung metastasis is sometimes treated with radiotherapy or resection, but most patients need systemic therapy. Cisplatin-paclitaxel was the reference doublet, with carboplatin an equivalent substitute after JCOG0505. GOG-240 added bevacizumab to chemotherapy in 2014 and extended median survival to about seventeen months, the first targeted therapy in the disease. Squamous, adenocarcinoma and adenosquamous histologies are treated alike, and PD-L1 combined positive score is measured because most trials selected or stratified by it.
KEYNOTE-826 added pembrolizumab to platinum-paclitaxel with or without bevacizumab and extended median overall survival in all comers from 16.8 to 26.4 months, with a hazard ratio of 0.63, and to 28.6 months in tumours with a combined positive score of one or more; it was approved in 2021 and is the first-line standard. BEATcc added atezolizumab to chemotherapy plus bevacizumab and reached a median survival of 32.1 months against 22.8, and COMPASSION-16 in China added the PD-1 and CTLA-4 bispecific cadonilimab with a survival hazard ratio of 0.64, confirming the class effect. Fitness for bevacizumab, prior pelvic radiotherapy and the risk of fistula shape the choice of partner drugs.
After platinum and immunotherapy, tisotumab vedotin, an antibody-drug conjugate against tissue factor, improved median survival from 9.5 to 11.5 months against chemotherapy in innovaTV 301 and gained full approval in 2024; ocular toxicity requires eye care and steroid drops. Cemiplimab improved survival from 8.5 to 12.0 months against chemotherapy in EMPOWER-Cervical 1 in immunotherapy-naive patients and remains relevant where first-line immunotherapy was not given. Trastuzumab deruxtecan produced responses in half of HER2-expressing cervical cancers in DESTINY-PanTumor02, sacituzumab tirumotecan is in phase 3, and tumour-infiltrating lymphocyte therapy has shown durable responses in small studies. How to sequence antibody-drug conjugates after first-line immunotherapy, and how to bring any of this to the low-income countries where most deaths occur, are the pressing questions.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Around one in ten cervical cancers present with distant spread and a third of locally advanced cases relapse; median survival was about a year before 2014, and first-line chemo-immunotherapy has now more than doubled it for many women.
Most high-grade ovarian cancers begin at the tip of the fallopian tube; endometrial cancer lines the uterus, cervical cancer starts at the transformation zone; each drains to a different node group.
Same organ: Adenosquamous carcinoma of the cervix, Small cell neuroendocrine carcinoma of the cervix, Bartholin gland carcinoma, Vulvar melanoma, Vaginal melanoma, High-grade serous ovarian cancer, Low-grade serous ovarian cancer, Clear cell ovarian cancer, Mucinous ovarian cancer, Adult granulosa cell tumour of the ovary, Ovarian cancer, Endometrial cancer, Cervical cancer, Vulvar cancer, Gestational trophoblastic neoplasia, Uterine sarcoma, Vaginal cancer, POLE-ultramutated endometrial cancer, Mismatch-repair-deficient endometrial cancer, p53-abnormal endometrial cancer, including uterine serous carcinoma, Endometrial cancer with no specific molecular profile, Advanced or recurrent endometrial cancer, Uterine carcinosarcoma, Early cervical cancer and fertility-sparing surgery, Locally advanced cervical cancer, Platinum-sensitive ovarian cancer, Platinum-resistant ovarian cancer, HPV-associated vulvar squamous cell carcinoma, HPV-independent vulvar squamous cell carcinoma (p53-mutant), Vaginal squamous cell carcinoma (HPV-associated), Vaginal adenocarcinoma (including DES-associated clear cell adenocarcinoma), Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk), Placental-site trophoblastic tumour and epithelioid trophoblastic tumour
Pembrolizumab with cisplatin or carboplatin, paclitaxel and, when safe, bevacizumab (KEYNOTE-826); atezolizumab with chemotherapy and bevacizumab (BEATcc) or cadonilimab with chemotherapy (COMPASSION-16, China) as alternatives.
Tisotumab vedotin (innovaTV 301) with prophylactic eye care; cemiplimab (EMPOWER-Cervical 1) if no prior immunotherapy.
Trastuzumab deruxtecan after prior therapy (DESTINY-PanTumor02).
Single-agent chemotherapy (topotecan, gemcitabine, pemetrexed, vinorelbine) with modest response; clinical trials of new antibody-drug conjugates and cell therapy preferred.
Pelvic exenteration in fit patients without sidewall fixation.
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HER2 immunohistochemistry is now worth doing in advanced gynaecological and other cancers, since trastuzumab deruxtecan is approved for HER2 3+ solid tumours after prior therapy.
Tisotumab vedotin is the standard second-line treatment for recurrent cervical cancer after chemo-immunotherapy, with a mandatory eye-care protocol.
Cemiplimab is an option for second-line cervical cancer in patients who have not had immunotherapy, though most now receive pembrolizumab first line, moving cemiplimab later or out of sequence.
Pembrolizumab plus chemotherapy with bevacizumab is the first-line standard for recurrent or metastatic cervical cancer with PD-L1 expression, which covers about nine in ten patients.
Platinum-paclitaxel with bevacizumab became the first-line standard for advanced cervical cancer and remains the backbone to which pembrolizumab is added.
Query for this cancer: (TITLE:"Recurrent or metastatic cervical cancer" OR ABSTRACT:"Recurrent or metastatic cervical cancer" OR TITLE:"Persistent, recurrent or metastatic cervical cancer" OR ABSTRACT:"Persistent, recurrent or metastatic cervical cancer" OR TITLE:"Stage IVB cervical cancer" OR ABSTRACT:"Stage IVB cervical cancer" OR TITLE:"Advanced cervical cancer" OR ABSTRACT:"Advanced cervical cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Recurrent or metastatic cervical cancer, not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
Temperature of 38 C or higher, or feeling shivery and unwell even without a fever. Antibody-drug conjugates suppress the bone marrow, and several carry a boxed warning for severe neutropenia.
Any new or worsening cough, breathlessness or fever. The label says to interrupt treatment for any suspected ILD and to permanently discontinue for grade 2 or higher.
Blurred vision, dry or gritty eyes, eye pain or light sensitivity; these products carry boxed warnings or requirements for eye examinations before each dose.
See all on the product pages:AtezolizumabBevacizumabCadonilimabCarboplatinCemiplimabCisplatinGemcitabinePaclitaxel / nab-paclitaxelPembrolizumabSacituzumab tirumotecanTisotumab vedotinTopotecanTrastuzumab deruxtecan·Printable cards in the navigator
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