Page 185 - EJMO-9-2

Eurasian Journal of
Medicine and Oncology PD-1/L1 inhibitors in advanced CC: Multicenter retro

was swiftly followed by revisions to the 2024 NCCN evaluate the association between biomarker expression
guidelines, which now endorse this combination as a first- and clinical outcomes. These refinements are anticipated
line therapeutic option for high-risk patients, including to bolster the scientific rigor and clinical relevance of our
those with bulky tumors (>4 cm), lymphovascular space findings, thereby furnishing a more robust evidence base
invasion, or suboptimal response to initial therapy. for the refinement of immunotherapy strategies in cervical
19
The updated guidelines demonstrate transformative cancer.
potential for global cervical cancer management. Notably,
in resource-limited settings where access to advanced 5. Conclusion
therapies remains challenging, earlier integration of Our findings demonstrate that primary treatment with
immunotherapy may help reduce outcome disparities PD-1/PD-L1 inhibitors can provide significant survival
across regions by circumventing radiation-dependent benefits for Chinese patients with advanced cervical
treatment paradigms. Conversely, in high-income cancer. Notably, patients with relatively early-stage and
countries, positioning immunotherapy as a cornerstone smaller tumors seemed to obtain more benefits than their
of multimodal therapeutic strategies could accelerate counterparts. These findings suggest that the identification
progress toward achieving the World Health Organization’s of a patient cohort with favorable clinicopathological
cervical cancer elimination targets. Collectively, these features and molecular markers may enable the
paradigm shifts herald a new era in oncology where development of an “immunotherapy-sensitive cervical
immunotherapy transitions from investigational concepts cancer” paradigm for precision oncology. Moreover,
to standard clinical practice. Meanwhile, ongoing clinical we have identified a critical window for the dynamic
trials evaluating rational combination approaches – remodeling of the tumor immune microenvironment.
particularly anti-PD-1 agents paired with PARP inhibitors Initiating immunotherapy at an earlier stage, when tumor
or anti-angiogenic therapies – are systematically exploring burden is minimal, may optimize therapeutic efficacy
synergistic mechanisms, with preliminary results showing by reversing T-cell exhaustion and remodeling the
promising potential to redefine therapeutic landscapes. immunosuppressive microenvironment. Hence, further
The present study is subjected to several limitations investigation is warranted to define optimal treatment
that warrant explicit acknowledgment. Primarily, the timing and patient selection better to maximize the
retrospective study design and the heterogeneity of the benefits of immunotherapy in advanced cervical cancer.
patient cohort may have introduced bias, as indicated by
(i) substantial disparities in case accrual between the two Acknowledgments
participating Centers and (ii) potential systematic errors None.
stemming from variations in clinician expertise, clinical
practices, and prescribing preferences concern PD-1/PD-L1 Funding
inhibitors. Second, the abbreviated follow-up duration None.
precluded a comprehensive assessment of the long-term
impact of immunotherapy on OS despite the observed Conflict of interest
PFS benefit, thereby necessitating extended follow-up data.
Furthermore, the exclusion of 5.8% (12/204) of cases due The authors declare they have no competing interests.
to missing critical clinical data (e.g., treatment response Author contributions
or follow-up records) may have engendered selection bias
in the survival analysis. Notably, the absence of PD-L1 Conceptualization: Haifeng Qiu
expression assay data in 57.3% (110/192) of patients, Formal analysis: Min Wang, Xia
potentially attributable to inadequate clinical detection rates Investigation: Dian Wang, Ning Su
due to assay costs, may have compromised the precision of Methodology: Min Wang, Xiao Li
the efficacy evaluation of PD-1/PD-L1 inhibitors. Writing – original draft: Min Wang
Writing – review & editing: Min Wang, Xiao Li
To mitigate the limitations above, we propose
the following methodological enhancements: Ethics approval and consent to participate
(i) implementation of a multicenter prospective cohort
study, incorporating standardized data acquisition and Written informed consent was not required for this study
a uniform therapeutic regimen, (ii) augmentation of because this is a retrospective study.
the sample size to 300 cases, coupled with an extended Consent for publication
follow-up duration of 36 months, and (iii) establishment of
a PD-L1 dynamic monitoring subgroup to systematically Not applicable.

Volume 9 Issue 2 (2025) 177 doi:10.36922/ejmo.8074