Cervical cancer: lines of therapy
13 standard-of-care settings across 6 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers | Risk group |
|---|---|---|
| Screening, prevention and diagnosis | 3 | · |
| Locally advanced | 2 | 1 |
| Advanced, first line | 2 | · |
| Second line | 1 | · |
| Third line and beyond | 1 | · |
| Other settings | 3 | · |
Screening, prevention and diagnosis
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Prevention | HPV vaccination age 9-14; HPV primary screening. | NCCN Guidelines: Cervical Cancer | 89 | |
| All comers | Primary prevention | HPV vaccination of girls (and boys) at 9-14, one or two doses per WHO; catch-up to 26 (US label to 45). Reduces invasive cancer ~90% when given before exposure. | NCCN · Prevention guideline | 89 | |
| All comers | Screening | HPV primary testing every 5 years from 25-30 (self-sampling accepted), or cytology every 3 years; VIA or HPV screen-and-treat in low-resource settings; WHO target 70% screened twice in a lifetime. | NCCN · USPSTF Grade A | 40 |
Locally advanced
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Locally advanced | Cisplatin chemoradiation + brachytherapy + pembrolizumab. | NCCN Guidelines: Cervical Cancer | 98 | |
| All comers | Locally advanced (IB3, IIB-IVA), standard | Weekly cisplatin 40 mg/m² with external-beam IMRT/IGRT followed by image-guided brachytherapy to ≥85 Gy EQD2, completed within 56 days. | NCCN · 1ESMO-MCBS · A | 91 | |
| Risk group | Locally advanced, high risk (node-positive IB2-IIB, III-IVA) | Add pembrolizumab during chemoradiation and for 15 maintenance cycles (KEYNOTE-A18, approved 2024 for FIGO III-IVA), or induction carboplatin-paclitaxel weekly × 6 before chemoradiation (INTERLACE). Adjuvant chemotherapy after chemoradiation is not recommended (OUTBACK). | NCCN · 1 (pembrolizumab); 2A (induction)ESMO-MCBS · A (KEYNOTE-A18) | 98 |
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Recurrent/metastatic | Pembrolizumab-chemotherapy-bevacizumab; tisotumab vedotin. | ESMO-MCBS · 2 (innovaTV 204 tisotumab vedotin, single-a… | 98 | |
| All comers | Persistent, recurrent, or metastatic, first line | Pembrolizumab + cisplatin/carboplatin-paclitaxel ± bevacizumab (KEYNOTE-826, CPS ≥1 in the US); atezolizumab + chemotherapy + bevacizumab (BEATcc, region-dependent); cadonilimab + chemotherapy in China (COMPASSION-16). | NCCN · 1ESMO-MCBS · 4 | 98 |
Second line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Pelvic recurrence after radiation | Pelvic exenteration in selected patients with central recurrence; re-irradiation with brachytherapy or proton therapy in specialised centres. | NCCN · 2A | 40 |
Third line and beyond
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Second line and beyond | Tisotumab vedotin (innovaTV 301, OS benefit); cemiplimab if immunotherapy-naive (EU); T-DXd for HER2 IHC 3+; pembrolizumab for MSI-H/TMB-high; single-agent chemotherapy; trials of sac-TMT and TIL therapy. | NCCN · 1 (tisotumab) | 97 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Precancer (HSIL / CIN2-3, AIS) | Colposcopy-directed biopsy then LEEP/LLETZ or cone excision; thermal ablation or cryotherapy where eligible; HPV test of cure at 6-12 months. | NCCN · ASCCP 2019 risk-based management | 40 | |
| All comers | Stage IA1-IB1 (≤2 cm) | Simple hysterectomy is non-inferior to radical for low-risk IA2-IB1 ≤2 cm (SHAPE trial, 2024); cone or trachelectomy for fertility preservation; sentinel node mapping in trials (SENTICOL III). | NCCN · 2A | 68 | |
| All comers | Stage IB2-IIA (surgical candidates) | Open radical hysterectomy with pelvic lymphadenectomy (minimally invasive approach inferior in LACC); adjuvant radiation or chemoradiation for intermediate/high-risk pathology (Sedlis, Peters criteria). | NCCN · 1 (open approach) | 91 |
Sequence and caution pairings
SequenceApproved
Induction chemotherapy → chemoradiation (locally advanced cervical cancer)
Six weeks of cheap chemotherapy before chemoradiation cut deaths by 40% (INTERLACE), while chemotherapy after chemoradiation did nothing (OUTBACK). Order matters.
CautionApproved
Caution: DXd ADC + agents with pneumonitis risk
Enhertu and its DXd cousins can inflame the lungs; combining them with immunotherapy, radiation, or mTOR inhibitors stacks that risk.
CautionStandard of care
Caution: minimally invasive radical hysterectomy for early cervical cancer
Keyhole radical hysterectomy, though less painful, led to more recurrences and deaths than open surgery in the LACC trial. Open surgery is the standard until protective techniques are proven.
Regimens in the library
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.