Integrating chemoradiotherapy and nivolumab in advanced cervical cancer: two case reports

Background: Cervical cancer is the fourth most common cancer among women globally, with high recurrence rates in locally advanced cases despite standard treatment with chemoradiotherapy and brachytherapy. Immune checkpoint inhibitors (ICIs), such as nivolumab, have shown promise in enhancing anti-tumor immunity, particularly when combined with conventional therapy. Emerging data suggest that integrating ICIs into treatment regimens for high-risk cervical cancer may improve survival and disease control. Cases: We present two cases highlighting this approach. A 77-year-old woman with clinical stage IIA cervical squamous cell carcinoma underwent radical hysterectomy with pT2a1N1M0 staging, followed by chemoradiotherapy and brachytherapy in 2021. One year later, recurrence in the para-aortic and iliac lymph nodes was detected and successfully treated with salvage radiation and concurrent chemo-immunotherapy using nivolumab. She achieved complete remission and remains disease-free at the latest follow-up. The second case involves a 39-year-old woman diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC1 cervical squamous cell carcinoma with human papillomavirus (HPV)-16 positivity. She received chemoradiotherapy, brachytherapy, and immunotherapy with nivolumab, achieving complete remission and HPV clearance. In December 2021, recurrence in the para-aortic lymph nodes was treated with additional radiation, chemotherapy, and ongoing nivolumab maintenance. A hysterectomy in 2023 for abnormal bleeding revealed no residual disease, and the patient continues to be disease-free. Conclusions: These cases illustrate the potential benefit of combining chemoradiotherapy with maintenance immunotherapy using ICIs. This strategy may enhance progression-free survival and achieve durable disease control in advanced or recurrent cervical cancer. However, challenges such as treatment-related toxicity and resistance must be addressed. Continued research is vital to refine therapeutic protocols, identify predictive biomarkers, and optimize patient selection to maximize the benefits of this evolving treatment paradigm.