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Promising Tumor Remission After Immunotherapy for Late Relapse of Locally Advanced Cervical Adenocarcinoma Revealed by [18F] Fluoro-2-Deoxy-DGlucose Positron Emission Tomography | Abstract
Gynecology & Obstetrics

Gynecology & Obstetrics
Open Access

ISSN: 2161-0932

Abstract

Promising Tumor Remission After Immunotherapy for Late Relapse of Locally Advanced Cervical Adenocarcinoma Revealed by [18F] Fluoro-2-Deoxy-DGlucose Positron Emission Tomography

Hsiu-Huei Peng, Kun-Ju Lin and Cheng-Tao Lin

The prognosis of patients with metastatic cervical cancer is poor, with a median survival of 8-13 months. Treatment with chemotherapeutic drugs alone is rarely curative. In the past few years, the development of immunotherapy, targeted therapy, angiogenesis inhibitors, and tyrosine kinase inhibitors has provided better treatment choices for patients with metastatic cervical cancer.

A 52-year-old woman was diagnosed on July 2001, with locally advanced adenocarcinoma of cervix, stage IIb. She underwent concurrent chemoradiotherapy resulting in complete remission for over 10 years. Unfortunately, she was found to have a late relapse of cervical adenocarcinoma with liver metastases (segments 7 and 8) on June 2013. She underwent segmental hepatectomy and cholecystectomy and was transferred to our gynecologic oncology service for standard chemotherapy with immunotherapy based on her immune risk profile (IRP). Immunomodulatory agents, including picibanil (OK-432), interferon-alpha, celecoxib (cyclooxygenase-2 inhibitor), thymalfasin, and aldesleukin (IL-2) were given. Approximately 20 months later, spleen metastasis was suspected by [18F] fluoro-2-deoxy-D-glucose positron emission tomography. The patient underwent gasless laparoscopic intraperitoneal treatment with immunomodulatory agent celecoxib (cyclooxygenase-2 inhibitor) and intraperitoneal immunoviral therapy to create host immunosurveillance for consolidation therapy. Three months later, there was complete remission of the metastatic splenic nodule on repeat imaging.

Our case demonstrates the dramatic promise of immunomodulatory therapy to induce complete remission of a metastatic cancer nodule. This case suggests the potential value of immunotherapy to augment host immunosurveillance to improve survival of metastatic cervical cancer.