Cemiplimab In Recurrent Cervical Cancer and Side Effects

Introduction:

Cancer is a grizzly disease that affects the body in various forms. Efforts are made to prevent and cure cancer, improve the quality of life, and improve disease free-survival rates and overall survival. Among serious cancers, one such cancer is cervical cancer. Various treatment modalities are already being delivered at various hospitals and cancer centers. Specific studies are being conducted to develop a more effective treatment for recurrent cervical cancer. In a few recent studies that were conducted in past years, results were published in early 2022. These studies showed superior efficacy of Cemiplumab when used in patients with recurrent cervical cancer.

What Is Recurrent Cervical Cancer?

Cancer of the cervix is called cervical cancer. Cervix is a part of the female reproductive system. Cervix connects the birth canal (vagina) to the womb (uterus), where the baby grows inside the mother’s body. It is caused by a dangerous virus called Human Papilloma Virus (HPV). As the age increases, the risk of developing cervical cancer increases too. It is very rare in children. When the cells inside the cervix undergo abnormal changes, it is known as dysplasia. The accumulation of these dysplastic cells causes cancer in the cervix. This cancer can be treated by chemotherapy, radiotherapy, and surgical therapy or as a combination therapy depending upon the stage of cancer. After the treatment, if cancer develops back again in the body, it is called recurrent cervical cancer.

What Are the Signs and Symptoms of Cervical Cancer?

Symptoms are the changes or discomfort experienced by the patient, while signs that cannot be seen are measured via investigations or tests like blood tests. The signs and symptoms listed here do not confirm the diagnosis of cervical cancer. The individual needs medical attention and a doctor’s advice for further investigations.

• Light bleeding after the periods.

• Menstrual bleeding is heavy and longer than usual.

• Vaginal bleeding following sex.

• Pain during sex.

• .Continuous back or pelvis pain.

• Abnormal discharge from the vagina.

What Are the Examinations Conducted to Confirm the Presence of Cervical Cancer?

• History And Physical Examination: Medical history and any other related information will be enquired by the doctor, such as health habits, lifestyle, and other illnesses. The body will be checked for any signs of the disease, like a lump or swelling.

• Pelvic Exam: The doctor shall examine the inner organs of the body like the vagina, cervix, uterus, ovaries, fallopian tubes, and rectum. In order to enable this, a speculum is passed through and inserted into the vagina to examine the above-mentioned organs of the female reproductive system. The doctor or a nurse is going to insert one or two gloved and lubricated fingers of one hand into the vagina, and the other hand is placed on the lower part of the abdomen to palpate and check for the size, shape, and position of the uterus and ovaries.

• Pap Test: This test uses a small brush that is inserted into the vagina and collects the tissue samples. This sample is sent to the laboratory for microscopic studies. This is also called a pap smear.

• Human Papillomavirus Test (HPV): This test is performed to detect the DNA (deoxyribonucleic acid) and RNA (ribonucleic acid). A small amount of sample is separated from pap smear exclusively for this test. The sample is then studied under a microscope to identify the viral DNA or RNA. This test is conducted only if the pap smear is positive for abnormal cervical cells.

• Endocervical Curettage: This test uses a spoon-shaped instrument that is inserted into the cervical canal to collect the sample. It is also called colposcopy.

• Colposcopy: It is a glowing and magnifying instrument that serves the same purpose as curettage. In this procedure, the sample is collected and sent to the laboratory for microscopic studies.

• Biopsy: A small amount of cancer tissue is collected from the cervix that is sent to the laboratory for further studies. If the doctor sees it as necessary to retrieve a larger sample, another procedure known as cervical bone marrow biopsy is performed. This procedure needs a longer duration at the hospital.

What Are the Treatment Modalities for Cervical Cancer?

One can find a generalized treatment regimen on the internet that includes a variety of drugs and other treatment options. It cannot be followed by everyone in the same way. Deciding a treatment is up to the doctor who goes through all the laboratory investigations and scan reports of that particular patient. The treatment will be patient-specific. The treatment of cervical cancer largely depends on factors like:

1. Stage of cancer.

2. Type of cancer.

3. Age of the patient.

4. The patient wishes to bear children.

There are few standard therapies to treat cervical cancer. They are listed as follows:

1) Surgical Therapy:

• Conization: It is also called a cone biopsy because the sample derived after surgery is sent to a laboratory for microscopic examination. This procedure is followed to remove a cone-shaped piece of tissue from the cervix. It is used to diagnose various other cervical conditions as well.

• Total Hysterectomy: Surgical removal of the uterus along with the cervix is termed hysterectomy. If the hysterectomy is performed via the abdomen, it is known as abdominal hysterectomy. Vaginal hysterectomy is when the uterus is removed surgically from the vagina. If a hysterectomy is done with the laparoscope, it is called a laparoscopic hysterectomy.

• Radical Hysterectomy: If, along with the uterus and cervix, other parts like lymph nodes, the wider area of surrounding tissues, ligaments, fallopian tubes, and ovaries are removed, it is called a radical hysterectomy. This procedure is followed in advanced stages of cervical cancer that has spread to surrounding areas of the female reproductive system.

• Radical Trachelectomy: When the cervix, the upper part of the vagina, and surrounding tissues are removed while preserving the uterus and ovaries, it is called a radical trachelectomy.

2) Radiotherapy:

Cancer therapy uses high-frequency or energy X-rays to kill or destroy cancer cells and control the growth of the tumor mass. There are two types of radiation therapy:

• External Beam Radiotherapy: In this, the source of radiation is outside the body, where a machine exposes the body to high-energy radiation that destroys the cancer cells. One such type of therapy is intensity-modulated radiation therapy (IMRT). IMRT is a 3D radiation therapy that uses a computer to scan the pictures of the cervix and then targets the tumor with intensified radiation.

• Internal Beam Radiation therapy: It uses needles, seeds, wires, or catheters to be inserted into or near the tumor mass.

3) Chemotherapy:

• It involves the use of drugs that identify and kill cancer cells. These drugs are given through the mouth, veins, or muscle. They act by entering the bloodstream and can reach cancer cells anywhere in the body.

4) Targeted Therapy:

In this therapy, the drugs are used to target the cancer cells specifically and destroy them. Hence, it reduces collateral damage and side effects that usually occur with the use of chemotherapy.

• Monoclonal Antibodies: These antibodies enhance the response of the body’s immune system. They are manufactured in laboratories. They identify the targets that help in the production of more cancer cells and destroy them. Some of the monoclonal antibodies that are a part of the approved treatment regimen and are already a part of the standard treatment regimen for cancer are Bevacizumab, Cemiplimab, and Pembrolizumab.

• Immunotherapy: This treatment is called biological therapy, as it boosts the immune system of the body, thereby helping to destroy the cancer cells. Pembrolizumab is one such drug that inhibits the immune checkpoint (programmed cell death PD 1), thereby increasing the response of the body to a foreign body (cancer cells).

What Is the Role of Cemiplimab in Treating Recurrent Cervical Cancer?

• Cemiplimab is a drug that provides immunotherapy to treat cancer. It is a monoclonal antibody that is manufactured in a laboratory that can restore, enhance, and modify the immune response of the body.

• It is a type of protein that acts as the body’s antibodies that control cancer from getting worse.

• The use of Cemiplimab is a newer type of treatment that has recently finished its trials on humans successfully. It gave hope to patients by increasing their quality of life and disease-free period. There are only a few treatment options for treating recurrent cervical cancer. Such patients often have a poor prognosis.

• Phase 1 Clinical Trials- In the initial trials, Cemiplimab showed a fully inhibitory action on an immune checkpoint, the programmed cell death 1 receptor (PD1). It was able to successfully bind to the PD1 receptor, thereby inhibiting its activity. This leads to an increase in the normal immune function of the body, thereby allowing the body to destroy cancer kills. This drug is approved for treating various other cancers like squamous cell carcinoma, non-small cell lung cancers, and advanced basal cell carcinoma.

• Phase 2 Clinical Trials- The use of Cemiplimab is yet to be approved for use in recurrent cervical cancer. It is still in phase-2 of clinical trials. Nevertheless, it showed favorable results by increasing medical survival and disease-free survival, along with progression-free of the trial patient.

• Phase 3 Clinical Trials- Researchers are expecting much more good results by the end of phase 3.

Conclusion:

Recurrent cervical cancers have a poor prognosis. Cemiplimab has surely increased the hope of treating cervical cancer in a better way. The survival was significantly longer with single-use chemotherapy involving Cemiplimab after the patient received platinum-based chemotherapy.