A CLINICAL CASE OF IMMUNOTHERAPY OF METASTATIC CERVICAL CANCER

Cervix cancer is the most common tumor disease in women. In Russia, the incidence of cervical cancer in 2018 was 17766 cases. In the Russian Federation, the death absolute numbers was 6,392 cases, with an average age of 57.8 years. In the Republic of Bashkortostan, 346 new cases of the disease were registered, including 117 cases of detection at stage III-IV of the disease. Approximately 75% of invasive cervical carcinomas are squamous cell carcinoma. Chemotherapy is the only one treatment option for the vast majority of patients with recurrent or metastatic disease. However, the successful use of platinum-containing regimens is associated with the development of adverse events; in particular, the sprout of myelopoiesis is inhibited. Frequent adverse effects are anemia, thrombocytopenia, neutropenia. For the last few years success has been achieved in cancer immunotherapy. Pembrolizumab is an anti-PD-1 monoclonal antibody that connects the PD-1 receptor and blocks interaction with PD-L1 and PD-L2, thereby releasing PD-1-mediated inhibition of the immune response, including an antitumor immune response.Case presentation. A patient with metastatic cervical cancer turned for specialized help complaining of pain in the lower abdomen. In the history of the disease, the patient had diathermoconization of the cervix, chemoradio therapy, evisceration of the pelvis with the formation of ileoconditis according to Bricker. Before starting therapy, MRI of the abdomen and pelvis was performed. One targeted lesion was isolated, in the right obturator fossa there was a conglomerate of lymph nodes. The sum of measurable foci was 38-mm. PDL1 status ≥ 1%, positive status of microsatellite instability (MSI) were determined. The patient received 25 courses of anti-PD1 / PDL1 therapy: pembrolizumab 200 mg every 21 days. According to the results of an MRI scan of the pelvic organs - the size of the measurable lesion is 15 mm; a partial response is achieved according to the RECIST / iRECIST criteria.Conclusions. In this case anti-PD1 / PDL1 therapy for advanced and metastatic cervical cancer helped to achieve partial or complete remission of the disease. Improvement of treatment results with addition of pembrolizumab into the treatment scheme is connected with a decrease in the size of the measurable lesion by more than 30%, a decrease in the number of adverse events, and an improvement in the general condition of the patient.

cervical cancer, PD-1, monoclonal antibody, immunotherapy, pembrolizumab

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