Case Report: Brain metastasis from cervical cancer treated with multimodal therapy

Brain metastasis from cervical cancer is exceptionally rare, occurring in 0.4%–2.3% of cases and portending a dismal prognosis, with a median survival of approximately 6.2 months after the diagnosis of brain metastasis. Here we report a 51-year-old woman initially diagnosed with stage IVB papillary squamous cell carcinoma of the cervix. Initial therapy combining albumin-bound paclitaxel, cisplatin, and the anti-PD-1 antibody tislelizumab, followed by pelvic radiotherapy, achieved durable disease control. Nineteen months after diagnosis, she developed memory decline and headache; brain MRI disclosed large, radiologically presumed metastases in the right frontal-basal ganglia and left occipital lobe. As the patient declined surgery, she received bevacizumab, paclitaxel, and the bispecific PD-1/CTLA-4 antibody iparomlimab/tuvonralimab (Ipa-tuv), together with focal fractionated VMAT (3900 cGy in 13 fractions) to the brain lesions. The dominant lesion decreased from 66 × 54 × 58 mm to 45 × 54 × 49 mm, and neurological symptoms resolved. Because of financial constraints, Ipa-tuv was later discontinued and she was maintained on bevacizumab plus chemotherapy. At the last two imaging time points, an increase in perilesional edema was noted; no clear size-based progression was demonstrated, although progression, radiation-related change, and treatment-related necrosis could not be excluded. At the last radiological assessment (January 25, 2026), the overall survival was approximately 34 months from the initial diagnosis and approximately 15 months since the diagnosis of radiologically presumed brain metastases. This case describes the observed response to a multimodal treatment strategy, although the contribution of any single component cannot be determined, and further prospective trials are warranted.