Advances in the Management of Cervical Cancer: Surgery, Systemic Therapy, and Immunotherapy

Cervical cancer is a leading global health burden, especially in the context of low- and middle-income countries where screening and vaccination coverage are still low. Although prevention strategies have improved; however, the case for effective treatment modalities remain. Cervical cancer has undergone significant changes in its management since the introduction of multiple therapeutic options over the years. Management of early-stage disease can entail surgical options including conization, hysterectomy, trachelectomy, and pelvic exenteration. Radiotherapy with external beam radiation or brachytherapy remains fundamental to treatment and is frequently administered alongside chemotherapy aimed at improving sensitivity. For locally advanced and metastatic disease, chemotherapy (especially platinum-based regimens) is still the mainstay of treatment, and newer targeted therapies appear effective. In the last few years, immunotherapy has appeared as a revolutionary strategy, among the immune checkpoint inhibitors, therapeutic vaccines, and adoptive cell therapies showed promising results. Moreover, novel targeted therapeutics and combination approaches are being investigated in clinical trials, ushering in an era of personalized medicine for the cervical cancer patient population. Although these advancements lead to improved outcomes for patients, issues related to treatment selection, quality of life, fertility preservation, and access to care continue to be of utmost importance. This review summarizes the status of lock-in treatments in cervical cancer, illustrating both current use and future directions for established and emerging lock-in therapies, with an eye on their real-world clinical implementation and future directions.