Immunotherapy may be the most effective treatment for cervical cancer when used early in the course of the disease, according to a research paper.

The paper, published in the journal Gynecologic Oncology, noted that despite the availability of human papillomavirus (HPV) vaccines, cervical cancer remains the second highest cause of cancer mortality among women in low and middle-income countries.

In India, cervical cancer is the second most common in women, making up close to 18 per cent of the new cancer cases, the International Agency for Research on Cancer (IARC), WHO's cancer agency has estimated.

The U.S. Food and Drug Administration has approved immunotherapy pembrolizumab in combination with chemotherapy and radiation therapy for treatment of locally advanced disease, the researchers said.

Novel therapeutic approaches for cervical cancer include combinations of immunotherapy and targeted agents, they said.

Immunotherapy aims to harness the power of the immune system to help eradicate cancer cells. It has a different side effect profile to traditional chemotherapy and may be better tolerated, noted Eugenia Girda, gynecologic oncologist at Rutgers Cancer Institute of New Jersey, US, the lead author of the paper.

Cervical cancer is usually caused by HPV. Vaccination for HPV remains the most important tool to help prevent this disease, Girda said.

"The combination of pembrolizumab with chemotherapy, with or without bevacizumab (cancer drug), significantly reduced risk of death among patients with recurrent or metastatic cervical cancer," the authors noted.

"Immunotherapy may be most effective when used earlier in the treatment course. In locally advanced cervical cancer, adding immunotherapy to chemoradiation has been shown to provide additional benefit and the hope is that the more patients might be cured with such an approach," they said.

This has been shown both in recurrent, metastatic disease, when immunotherapy is combined with chemotherapy, as well as in primary setting for treatment of locally advanced disease, the researchers said.

Studies are ongoing to identify patients most likely to benefit from immunotherapy.

Multiple studies have shown that the HPV vaccination is safe, effective and should be given before infection with HPV has occurred, the researchers said.

"Therefore, we need to improve the uptake of HPV vaccinations to completely eradicate cervical cancer, likely it has already been done successfully in some countries," they added.

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