JMBD Journal

Abstract

Background: Metastatic cervical squamous cell carcinoma (mCSCC) is a rare and aggressive form of cervical cancer with limited treatment options and poor prognosis, especially in cases involving pulmonary and lymphatic metastases. Traditional therapies such as chemotherapy and radiotherapy are often insufficient for long-term disease control, highlighting the need for innovative and multidisciplinary approaches. Case Presentation: We report the case of a 49-year-old woman diagnosed with invasive squamous cell carcinoma of the cervix in September 2022, complicated by metastases to the lungs and retroperitoneal lymph nodes. Initial treatment included concurrent chemoradiotherapy and brachytherapy, which effectively reduced the primary cervical tumor but left residual metastatic disease. Disease progression in early 2023 led to the initiation of combination therapy with sintilimab, liposomal paclitaxel, and cisplatin, followed by "PRaG Therapy"—a novel regimen integrating lung metastases radiotherapy, GM-CSF, sintilimab, and IL-2. This approach resulted in significant tumor regression and improved systemic control. Maintenance therapy with GM-CSF, sintilimab, and bevacizumab further stabilized the disease. By July 2024, the patient achieved sustained disease control with no new metastatic lesions, improved quality of life, and stable tumor markers. Conclusion: This case highlights the importance of a multidisciplinary approach, combining standard therapies with innovative immunotherapy strategies such as "PRaG Therapy," in managing metastatic cervical cancer. It underscores the potential of immune activation and personalized treatment regimens to improve outcomes in advanced disease.

Keywords: Metastatic cervical squamous cell carcinoma; Multidisciplinary treatment; Immunotherapy; "PRaG Therapy; Sintilimab

Abbrivations: MCSCC: Metastatic Cervical Squamous Cell Carcinoma; FIGO: International Federation of Gynecology and Obstetrics; EBRT: External Beam Radiotherapy; CCRT: Concurrent Chemoradiotherapy; SBRT: Stereotactic Body Radiotherapy; GM-CSF: Granulocyte-Macrophage Colony-Stimulating Factor; IL-2: Interleukin-2; PD-1: Programmed Death-1;PD-L1: Programmed Death Ligand-1; VEGF: Vascular Endothelial Growth Factor; ICI: Immune Checkpoint Inhibitor; SCC: Squamous Cell Carcinoma Antigen; CEA: Carcinoembryonic Antigen; PET/CT: Positron Emission Tomography/Computed Tomography; GTV: Gross Tumor Volume; CTV: Clinical Target Volume; ECOG: Eastern Cooperative Oncology Group