The role of immunotherapy in the treatment of advanced cervical cancer: New guidelines and future perspectives

Cervical cancer is one of the most common malignancies globally, particularly prevalent in low-and middle-income countries, and is the second most prevalent cancer-related cause of death.Despite the improvement in screening and preventive efficacy of the HPV vaccines, the majority of these cancers are diagnosed at a late stage where traditional therapies like chemotherapy and radiotherapy are of minimal benefit with disappointing long-term survival.In the past few years, immunotherapy has emerged as a breakthrough approach in oncology, offering new treatment options for recurrent or advanced cervical cancer.This narrative review discusses the current place and future directions of immunotherapy in advanced cervical cancer.The review addresses key mechanisms of tumor immune escape including HPV-mediated expression of viral oncoproteins E6 and E7, PD-L1 overexpression, and the immunosuppressive tumor microenvironment.The review criticizes several immunotherapeutic modalities such as immune checkpoint inhibitors (e.g., pembrolizumab, nivolumab), adoptive cell therapies (CAR-T, TILs), therapeutic vaccines, and monoclonal antibodies.Furthermore, it highlights the rationale and clinical benefit of combining immunotherapy with chemotherapy, radiotherapy, and targeted agents such as bevacizumab, as in trials such as KEYNOTE-826.While immunotherapy is a paradigm change in the treatment of cervical cancer, there are challenges.These are lack of access, cost of therapy, immune resistance, and need for predictive biomarkers.These limitations will be overcome by research and global health policy to make immunotherapy a just and effective option for all patients with cervical cancer.