Survival in Recurrent Cervical Cancer

Our flight from Boston to Los Angeles takes off in 3 days! We have a lot to get done before then.

Today, I decided to share a new article, Survival with Cemiplimab in Recurrent Cervical Cancer, from the New England Journal of Medicine. The first author of the study, Dr. Krishnansu Tewari, is from UC Irvine and the last author, Dr. Ana Oaknin, is from Barcelona.

Of course recurrent cervical cancer portends a poor prognosis. This study looked at Cemiplimab (Libtayo, Regeneron Pharmaceuticals) to see if it had an impact on survival. This is a PD-1 inhibitor previously approved to treat non small cell lung and basal and squamous skin cancers. This study was a randomized trial of 608 women and the researchers found that median overall survival was longer in the cemiplimab group than in the chemotherapy group (12.0 months vs. 8.5 months. The authors concluded that survival was significantly longer with cemiplimab than with single-agent chemotherapy among patients with recurrent cervical cancer after first-line platinum-containing chemotherapy.

My thoughts are this was a reasonably well conducted randomized trial (funded by Regeneron and Sanofi). Immune mediated adverse reactions, which can be severe, were not a major issue in this study. Grade 3 adverse events were actually more common in the standard of care arm than the cemiplimab arm. This very expensive drug lengthened life by a few months, which is consistent with what we see in many oncology clinical trials.

However, I’m an “apple a day” kind of doctor, so I’m more interested in preventing cervical cancer than treating it once it’s advanced. And 85% of worldwide cervical cancer deaths occur in settings with limited resources. Globally the issue is screening for cervical cancer is rarely available. Access to colposcopy and cytology are very limited in many countries, so instead public health experts recommend HPV testing and visual inspection. Another preventive method is HPV vaccination, which is effective in preventing cervical disease, including cervical intraepithelial neoplasia (CIN2 or 3) and adenocarcinoma in situ.

So the question for the economists is, how should we spend our “cervical cancer money” globally? On a PD-1 inhibitor which gives a few more months of life, or screening and vaccine programs which could prevent many cases of his disease?

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