Cervical cancer 2015 and beyond: a focus on innovative treatments and attention to survivorship.

Linda R. Duska, MD Cervical cancer is primarily a disease of less-developed countries. In contrast, for countries with established screening programs and access to medical care, the number of cases of cervical cancer has declined significantly over the past few decades. With the introduction of human papillomavirus (HPV) testing/typing and increasing uptake of the HPV vaccine, it is anticipated that HPV-related cervical disease (both preinvasive and invasive) will ultimately become obsolete in developed countries. The robust vaccination program in Australia illustrates this point, as it has nearly eradiated genital warts after 5 years. Unfortunately, cervical cancer continues to be a cause of significant morbidity and mortality around the world, primarily for women in countries where there are no screening and vaccination programs. With 528,000 new cases every year, cervical cancer is the fourth most common cancer affecting women worldwide, after breast, colorectal, and lung cancers. It is also the fourth most common cause of cancer death (266,000 deaths in 2012) in women worldwide. Moreover, even in the United States, 12,360 cases of cervical cancer were anticipated in 2014 and 4020 deaths from the disease. These cases of cervical cancer are primarily due to screening failures as a result of lack of access to care. Despite the ability to entirely prevent this disease, there are still women in the United States who die of cervical cancer each year. Although the cure rates for early disease (stage I) are excellent, at 80% depending on tumor size, the cure rates for locally advanced cervical cancer are far lower, at 50%. Bevacizumab was recently approved by the US Food and Drug Administration as an addition to the armamentarium of drugs available to treat advanced and recurrent cervical cancer; the cure rates, however, for advanced and recurrent disease remain dismally low. Perhaps equally important, the adverse effects of the treatment for all stages of cervical cancer are substantial and often lifelong, particularly for those women who require treatment with radiation therapy. Even young women with early-stage disease who are likely to be cured will face long-term adverse effects from radical surgery, including loss of their fertility. For the focused edition of Clinical Therapeutics on cervical cancer that was published in January 2014, we chose to emphasize prevention via vaccination, arguably the most important instrument in our toolbox for managing this potentially preventable disease. Unfortunately, the decrease in incidence of cervical cancer as a result of HPV vaccination will be decades in the future, and, more importantly, the uptake of the vaccine in the United States continues to be unacceptably low. As a result, in this issue of Clinical Therapeutics, we chose to focus instead on 2 main topics: (1) the development of new treatment options for current and future women facing this disease; and (2) the management of treatment sequelae. Patients with advanced or recurrent cervical cancer have a bleak prognosis, and innovative noncytotoxic treatment regimens are urgently needed. There is extensive evidence that cisplatin-based combination chemotherapy is the best treatment option for these women; the most recent data support the addition of bevacizumab.