Gynecology and pelvic medicine · 2026
Gynecologic management of cervical cancer patients undergoing immunotherapy: an up-to-date narrative review.
СтатьяОбзорНазвание и аннотация: Перевод пока не подготовлен
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Delgado Henrique, Lopes Caio, Queiroz Gledison, Lima Pedro Henrique, Lemos Carol, Cardôso Henrique, Mota Mateus, Oliveira Renata, Oliveira Ingrid, Paulino Renato, de Melo Fabrício
Аннотация
BACKGROUND AND OBJECTIVE: Cervical cancer (CC) remains a significant global health challenge, especially in low and middle-income countries. The advent of immune checkpoint inhibitors (ICIs), such as anti-PD-1/PD-L1 agents, has introduced promising therapeutic options for advanced and recurrent cases. However, gynecologic management during immunotherapy is poorly characterized, particularly regarding structured pre-treatment evaluation, integrated oncology-gynecology surveillance, timed contraception and fertility preservation, management of immune-mediated genital-tract fistulas (GTFs), and evidence-based approaches to pregnancy planning and endocrine dysfunction. This narrative review synthesizes evidence on gynecologic management of CC patients receiving immunotherapy, clinical decision frameworks, and identifies knowledge gaps requiring further investigation.
METHODS: A structured search was performed in PubMed, Web of Science, and the Cochrane Library (January 2015-October 2025) using MeSH terms and keywords for cervical cancer, immunotherapy, ICIs, gynecologic management, and fertility or pregnancy. Only original articles, case reports, guidelines, and reviews in English or Spanish were included. References were supplemented by artificial intelligence (AI)-based retrieval using SciSpace, OpenEvidence, and Perplexity Pro; deduplication ensured AI-derived citations were only retained as "AI-supplementary" when not present in database searches. ChatGPT-5 Thinking was applied solely for English translation and technical editing, with no generative content added to scientific findings.
KEY CONTENT AND FINDINGS: While ICIs (e.g., nivolumab, pilinumab, tisotumab, pembrolizumab, cemiplimab) have improved outcomes for advanced or metastatic CC, specific guidance for gynecologic management remains limited. Findings show that standard gynecologic screenings [human papillomavirus (HPV), cytology] proceed unchanged but should be aligned with oncology visits. Fertility preservation, via oocyte/embryo cryopreservation, and highly effective contraception are essential before, during, and after therapy. ICIs are discouraged during pregnancy; if pregnancy is detected, treatment should be interrupted. Proactive surveillance for immune-related adverse events (irAEs), including the emerging risk of GTF is crucial, especially within the first 6-8 weeks.
CONCLUSIONS: Immunotherapy advances care for recurrent/metastatic CC but gynecologic management remains insufficiently addressed. Evidence for fertility counseling, reproductive monitoring, and managing gynecologic irAEs is fragmented. This review underscores the need for interdisciplinary oncology-gynecology coordination, clearer practice protocols, and future research focused on women of reproductive age undergoing ICIs.
METHODS: A structured search was performed in PubMed, Web of Science, and the Cochrane Library (January 2015-October 2025) using MeSH terms and keywords for cervical cancer, immunotherapy, ICIs, gynecologic management, and fertility or pregnancy. Only original articles, case reports, guidelines, and reviews in English or Spanish were included. References were supplemented by artificial intelligence (AI)-based retrieval using SciSpace, OpenEvidence, and Perplexity Pro; deduplication ensured AI-derived citations were only retained as "AI-supplementary" when not present in database searches. ChatGPT-5 Thinking was applied solely for English translation and technical editing, with no generative content added to scientific findings.
KEY CONTENT AND FINDINGS: While ICIs (e.g., nivolumab, pilinumab, tisotumab, pembrolizumab, cemiplimab) have improved outcomes for advanced or metastatic CC, specific guidance for gynecologic management remains limited. Findings show that standard gynecologic screenings [human papillomavirus (HPV), cytology] proceed unchanged but should be aligned with oncology visits. Fertility preservation, via oocyte/embryo cryopreservation, and highly effective contraception are essential before, during, and after therapy. ICIs are discouraged during pregnancy; if pregnancy is detected, treatment should be interrupted. Proactive surveillance for immune-related adverse events (irAEs), including the emerging risk of GTF is crucial, especially within the first 6-8 weeks.
CONCLUSIONS: Immunotherapy advances care for recurrent/metastatic CC but gynecologic management remains insufficiently addressed. Evidence for fertility counseling, reproductive monitoring, and managing gynecologic irAEs is fragmented. This review underscores the need for interdisciplinary oncology-gynecology coordination, clearer practice protocols, and future research focused on women of reproductive age undergoing ICIs.