Title: Pembrolizumab with chemotherapy for treating recurrent, persistent or metastatic cervical cancer [ID3798]
Funder: Department of Health and Social Care

Abstract: Cervical cancer develops when abnormal cells in the lining of the cervix grow in an uncontrolled way and eventually form a tumour. [1] It can start from different types of cells in different parts of the cervix, which gives rise to two subtypes of cancer. The most common subtype, called squamous cell carcinoma, develops from skin-like cells present on the outer surface of the cervix (ectocervix). The other subtype is called adenocarcinoma and it develops from glandular cells that produce mucus inside the cervix (endocervix). [1] Infection with human papillomavirus (HPV) is associated with the development of cervical cancer. [2] It has been detected in 99.7% of cases. HPV types 16 and 18 are considered high risk for cervical cancer and cause about 75% of cases.[2] _x000D_ _x000D_ Cervical cancer is defined as recurrent when it has returned following treatment, and as persistent when it does not respond to treatment.[3] Cervical cancer is defined as metastatic when it has spread beyond the cervix to other places in the body such as the abdomen, liver, gut, or lungs (stage 4B). [3] Locally advanced cervical cancer (between stages 1B2 and 4A) is characterised either by a large tumour within the cervix (more than 4 centimetres) or tumour growth into the tissues around the cervix.[4]_x000D_ _x000D_ There are around 3,200 new cervical cancer cases in the UK every year. [5] In England in 2018, there were 2,668 newly diagnosed cases of cervical cancer. [6] In 2017, 730 deaths were recorded in England and Wales due to the cervical cancer. [7] Around 6 in 10 (61.4%) of people diagnosed with cervical cancer in England survive their disease for five years or more. [5] For people with recurrent, persistent or metastatic cervical cancer the aim of treatment is to relieve symptoms and improve quality of life. Treatment options may include chemotherapy with paclitaxel plus either cisplatin or carboplatin. NICE recommends topotecan in combination with cisplatin as an option for treating recurrent or stage 4B cervical cancer in people who have not previously received cisplatin (NICE Technology Appraisal Guidance 183). Bevacizumab in combination with paclitaxel and either cisplatin or carboplatin is also available via the Cancer Drugs Fund for untreated recurrent or metastatic cervical cancer. [8] When chemotherapy is not suitable, people may be offered best supportive care or palliative radiotherapy.[9]_x000D_ _x000D_ References_x000D_ _x000D_ 1. Cancer Research UK. What is cervical cancer? (2020). Accessed January 2022._x000D_ 2. National Institute for Health and Care Excellence. What causes cervical cancer? (2017). Accessed January 2022._x000D_ 3. Cancer Research UK. Stage 4 cervical cancer (2020). Accessed January 2022._x000D_ 4. Cancer Research UK. About advanced cervical cancer (2020). Accessed January 2022._x000D_ 5. Cancer Research UK. Cervical cancer statistics (2020). Accessed January 2022._x000D_ 6. Public Health England. Case-mix adjusted percentage of cancers diagnosed at stages 1 and 2 for Clinical Commissioning Groups in England (experimental statistics), diagnosed 2013 to 2018 – Table 3 (2020). Accessed January 2022._x000D_ 7. Office for National Statistics. Death registrations summary tables – England and Wales (2018). Accessed January 2022._x000D_ 8. NHS England. National Cancer Drugs Fund List ver1.167 (2020). Accessed January 2022._x000D_ 9. Reed N, Balega J, Barwick T et al. British Gynaecological Cancer Society (BGCS) Cervical Cancer Guidelines: Recommendations for Practice (2020). Accessed January 2022.

Lay abstract: To appraise the clinical and cost effectiveness of pembrolizumab in combination with platinum-based chemotherapy within its marketing authorisation for treating recurrent, persistent or metastatic cervical cancer.

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: CANCER AND NEOPLASMS