The exploration of iparomlimab and tuvonralimab combined with de−escalated chemotherapy as an innovative neoadjuvant treatment strategy for locally advanced cervical cancer: a case report from the NICE-CC trial

Recent research has explored the potential of using neoadjuvant dual immune checkpoint inhibitors (ICIs) combined with de−escalated chemotherapy in several locally advanced tumors to determine if such a combined regimen can enhance tumor response while minimizing toxicity. However, few related studies are focused on locally advanced cervical cancer (LACC). In this study, we present a case from the NICE-CC trial evaluating the feasibility of neoadjuvant dual immune checkpoint inhibitor (ICI) combined with a de-escalated chemotherapy regimen for LACC. A patient with stage IIB LACC had a high tumor burden and a presumed “immune cold” status, indicated by PD-L1 negativity with a Combined Positive Score (CPS) of 0. The patient achieved a pathological complete response (pCR) after receiving one cycle of neoadjuvant iparomlimab and tuvonralimab (simultaneously targeting PD-1 and CTLA-4) combined with standard chemotherapy, followed by two additional cycles of iparomlimab and tuvonralimab. Mechanically, the tumor microenvironment (TME) in this case was characterized by an abundance of tumor-infiltrating lymphocytes (TILs) and tertiary lymphoid structures (TLSs), which might be associated with improved responses to ICI therapy. In conclusion, this case highlights the potential of one cycle of neoadjuvant dual immunotherapy combined with standard chemotherapy, followed by two additional cycles of dual immunotherapy, for the treatment of LACC. This innovative treatment regimen warrants further investigation in the ongoing NICE-CC trial.