Background Recurrent cervical cancer following definitive radiotherapy remains a difficult clinical problem, particularly in low- and middle-income countries. Although immune checkpoint inhibitors have shown activity in this setting, their cost and prolonged treatment duration limit real-world accessibility. Strategies that retain biological activity while improving affordability are therefore needed. Methods We conducted a retrospective review of 21 patients with recurrent cervical cancer previously treated with radiotherapy or chemoradiotherapy. Patients received a fixed low dose of nivolumab (20 mg intravenously every two weeks) combined with metronomic oral chemotherapy using either methotrexate or capecitabine. Clinical outcomes included progression-free survival, overall survival, response rates, and toxicity. Results The overall response rate was 38%, seen in eight patients, and disease control was achieved in 14 (67%). Median progression-free survival was approximately 8.6 months, and median overall survival was about 15 months. One-year and two-year overall survival rates were 61% and 42%, respectively. Treatment was generally well tolerated, with mostly grade 1/2 adverse events and no treatment-related deaths. Conclusion Low-dose nivolumab combined with metronomic chemotherapy appears to be a reasonable and pragmatic option for selected patients with recurrent cervical cancer, particularly in settings where access to standard immunotherapy is limited. These observations support further prospective evaluation.
Ramidi et al. (2026) studied this question.