2025 Year-End Review – Professor Li Li: From Norm Popularization to Precision Treatment, Reviewing the Annual Advances in Cervical Cancer Diagnosis and Treatment
In 2025, the prevention and treatment of cervical cancer in the field of gynecologic oncology in China achieved multidimensional breakthroughs, with continuous innovation in clinical treatment regimens, rapid implementation of precision diagnosis and treatment technologies, and constant improvement of regional prevention and control systems. The integration of immunotherapy throughout the entire disease course, international recognition of original surgical regimens, and standardized advancement of personalized diagnosis and treatment have created a brand-new landscape for cervical cancer prevention and treatment. Invited by Gynecology and Obstetrics Network, Professor Li Li from The Affiliated Tumor Hospital of Guangxi Medical University conducted a systematic sorting and in-depth interpretation of the core breakthroughs, clinical pain points and future directions of the whole year, combining the academic layout of the Chinese Society of Clinical Oncology (CSCO) Gynecologic Oncology Committee, the prevention and control practice in Guangxi and the cutting-edge progress nationwide, so as to provide references for the optimization of clinical diagnosis and treatment and the implementation of regional prevention and control.
Multidimensional Advances and Practical Exploration in Clinical Treatment of Cervical Cancer in 2025
2025 has yielded fruitful outcomes in the field of cervical cancer diagnosis and treatment. Original Chinese research and clinical regimens have provided core support for the development of the field, ranging from the multi-line breakthroughs and strategic upgrading of immunotherapy, the evidence-based establishment of standard regimens for postoperative high-risk patients, the evaluation of the clinical value of induction chemotherapy for advanced locally advanced cervical cancer (LACC), to the innovative breakthroughs in early surgical models.
PART 01 Comprehensive Integration of Immunotherapy, Domestic Drugs Dominate Multi-line Treatment
Immunotherapy has become one of the core approaches for cervical cancer treatment, featuring a distinct characteristic of "dominance of domestic drugs and multi-line coverage".
First-line treatment: Breaking the previous single paradigm of only Pembrolizumab combined with chemotherapy, domestic drugs such as Cadonilimab have been successfully included in first-line treatment. The combination of domestic immunotherapeutic drugs and chemotherapy provides more options for patients, with efficacy comparable to imported drugs and significantly improved accessibility. Four phase III trials, namely KEYNOTE-826, COMPASSION-16, BEATcc and SHR-1210-III-329, have achieved positive outcomes across the board in first-line treatment for recurrent/metastatic cervical cancer (R/M CC), providing a variety of options for clinical practice!
Second-line treatment: Targeted-immunotherapy combination regimens have become an important breakthrough in palliative care for patients with advanced recurrent cervical cancer. Combination regimens such as Famitinib Malate plus Camrelizumab have significantly improved the therapeutic effect of patients with advanced recurrent cervical cancer and broken the efficacy bottleneck of traditional chemotherapy.
Dose and process optimization: The 2025 update of the NCCN Guidelines has adjusted the dosage strategy for immunotherapy. For example, when radiotherapy is combined with Pembrolizumab, the dosage is adjusted from 400 mg to 200 mg, and restored to 400 mg during the maintenance treatment stage. Meanwhile, the treatment administration interval is optimized to reduce the risk of toxicity on the premise of ensuring efficacy.
PART 02 Standardized Regimens for Postoperative High-risk Patients (Included in the Chinese Version of the NCCN Guidelines)
For patients with positive pelvic lymph nodes,/or positive surgical margins,/or positive parametrial tissue after radical hysterectomy, the TP regimen (paclitaxel plus cisplatin) - external beam radiotherapy (EBRT) ± brachytherapy - TP regimen is recommended. This regimen can significantly reduce the risk of recurrence and has been proven to demonstrate a definite overall survival benefit. Supported by domestic evidence-based evidence, it has been officially included in the Chinese version of the NCCN Guidelines.
PART 03 Clinical Value and Limitations of Induction Chemotherapy for Advanced LACC
For patients with advanced cervical cancer (Stage Ⅲ-Ⅳ), the regimen of 2 cycles of TC induction chemotherapy (paclitaxel plus carboplatin) combined with radical radiotherapy can enhance radiosensitivity by downstaging tumors and reducing tumor volume, thus significantly improving the survival of LACC patients. However, the INTERLACE study enrolled a limited number of high-risk LACC patients and excluded those with positive para-aortic lymph nodes; subgroup analysis of overall survival (OS) showed that the hazard ratio (HR) of high-risk LACC patients was less than 1, but the confidence interval (CI) was wide. Therefore, the survival benefit of induction chemotherapy combined with concurrent chemoradiotherapy in high-risk LACC patients remains uncertain.
PART 04 The PHENIX Study Rewrites Surgical Standards and Significantly Reduces the Risk of Recurrence
The PHENIX Study (a comparison of sentinel lymph node biopsy versus pelvic lymph node dissection), led by Professor Liu Jihong from China, has achieved a milestone achievement. The study confirmed that sentinel lymph node biopsy can replace traditional systematic pelvic lymph node dissection in patients with early cervical cancer (Stage Ⅰ-Ⅱ), with a 3-year disease-free survival (DFS) rate of 96.9%, which is not significantly different from that of the dissection group (97.1%). Meanwhile, the incidence of complications such as postoperative lymphedema and nerve injury is reduced by 60%. The study has been published in The New England Journal of Medicine (NEJM) and announced at top international conferences such as the Society of Gynecologic Oncology (SGO) Annual Meeting. It is expected to be included in the NCCN Guidelines and domestic guidelines in 2026, driving the era of precision and minimally invasive surgery for early cervical cancer.
Core Contradictions and Key Considerations of Personalized Diagnosis and Treatment
Personalized diagnosis and treatment of cervical cancer needs to strike a balance between "standardization" and "personalization". Combined with the actual situation of primary diagnosis and treatment in Guangxi, the core contradictions and key considerations are as follows.
PART 01 Core Contradictions
Contradiction between standardized treatment and individual adaptation: Some primary medical institutions adopt empirical treatment that deviates from clinical guidelines, while overemphasizing personalization may lead to therapeutic chaos.
Contradiction in balancing maximum efficacy and regional medical accessibility: The implementation of high-priced new drugs and complex treatment technologies is limited in the old, revolutionary, remote and poor areas of Guangxi, and economic factors have become an important constraint in the formulation of personalized regimens.
PART 02 Key Considerations
Adhere to "evidence-based foundation and standardization first": Personalized treatment is by no means an arbitrary choice. It must be based on the standardized framework of drug labels and guideline recommendations, supported by high-level evidence-based evidence, and avoid "empirical treatment" that deviates from standards.
Balance the three core goals: Treatment regimens must meet the three core principles of efficacy, low toxicity and cost-effectiveness. Especially in primary and ethnic minority areas of Guangxi, drugs and technologies covered by medical insurance and with affordable prices should be prioritized to ensure treatment continuity.
Strengthen the concept of "comprehensive whole-course management": When formulating personalized regimens, it is necessary to comprehensively plan the entire treatment process, clarify the sequence and timing of transition between surgery, radiotherapy, chemotherapy and immunotherapy, avoid conflicts in treatment plans among different physicians, and ensure treatment continuity.
Adapt to the individual characteristics of patients: Comprehensively consider tumor stage, pathological subtype, molecular biomarkers (e.g., PD-L1 expression), performance status, fertility requirements and comorbidities to realize "a personalized treatment plan for each patient".
CSCO Layout and Future Directions: Facilitating the Accelerated Elimination of Cervical Cancer
Combined with the academic layout of the CSCO Gynecologic Oncology Committee and the local prevention and control needs, the future work needs to further focus on three key directions to facilitate the implementation of the WHO 2030 "90-70-90" targets for cervical cancer elimination.
PART 01 Core Layout of CSCO
Strengthen screening and intervention for precancerous lesions: Continuously promote HPV vaccination (free HPV vaccination for all has been realized in some provinces), expand the screening coverage of high-risk groups, and especially strengthen the early detection and early treatment of precancerous lesions in remote areas of Guangxi to reduce the incidence of cervical cancer at the source.
Optimize clinical treatment pathways: For early-stage patients, popularize the sentinel lymph node biopsy technology verified by the PHENIX Study and standardize the scope of application of fertility-sparing surgery; for advanced-stage patients, popularize effective regimens such as targeted-immunotherapy combination and sequential therapy to reduce the mortality rate.
Promote the implementation of standardization in primary care: Improve the level of standardized diagnosis and treatment of cervical cancer in primary medical institutions in Guangxi through academic training, guideline interpretation and other initiatives, and narrow the regional disparities in medical care.
PART 02 Priority Research Directions
Explore more precise molecular biomarkers: Explore the correlations between biomarkers such as HPV genotyping, homologous recombination deficiency (HRD) and PD-L1 expression and treatment efficacy to realize "biomarker-guided precision treatment".
Optimize immunotherapy combination strategies: Conduct research on combination regimens of immunotherapy with radiotherapy, chemotherapy and targeted therapy to further improve the efficacy for advanced patients and significantly reduce the risk of recurrence.
Develop simplified treatment regimens suitable for primary care: On the premise of ensuring efficacy, explore low-cost and easy-to-implement treatment models to improve the accessibility of treatment in remote areas.
PART 03 Pathways to Facilitate the Elimination of Cervical Cancer
The WHO 2030 "90-70-90" targets (90% of girls under 15 years old are vaccinated against HPV, 70% of women aged 35 and 45 receive high-quality screening, and 90% of diagnosed patients receive standardized treatment) bring both challenges and opportunities to China. With a large population base and a high incidence of cervical cancer, China needs to advance the following measures: expand the coverage of HPV vaccination, with a special focus on improving the vaccination rate of girls in central and western regions such as Guangxi; improve the closed-loop management of screening-diagnosis-treatment and establish a green channel for patient referral in remote areas to ensure that diagnosed patients receive standardized treatment in a timely manner; continuously carry out high-quality local clinical research to provide more adapted treatment regimens for Chinese patients, and drive the continuous iteration of diagnosis and treatment level with high-quality evidence-based evidence.
Summary
In 2025, the prevention and treatment of cervical cancer in the field of gynecologic oncology achieved multiple breakthroughs in immunotherapy, surgical technology and treatment models, while personalization, standardization and whole-course management are the core principles of clinical practice. In the future, it is necessary to take a multi-pronged approach including screening and prevention, clinical research and primary care empowerment to gradually narrow regional disparities in medical care, and contribute Chinese wisdom and strength to the global goal of eliminating cervical cancer.
Expert Profile
Professor Li LiThe Affiliated Tumor Hospital of Guangxi Medical UniversityProfessor, Chief Physician, Doctoral Supervisor, Postdoctoral Supervisor
❖ Director of the Guangxi Clinical Treatment Quality Control Center for Gynecologic Oncology
❖ Standing Director of the Chinese Society of Clinical Oncology (CSCO), Chairman of the CSCO Gynecologic Oncology Committee
❖ Standing Director of the 6th Council of the Chinese Anti-Cancer Association (CACA)
❖ Vice Chairman of the 4th and 5th CACA Gynecologic Oncology Committee
❖ Standing Committee Member of the 1st and 2nd Chinese Medical Doctor Association (CMDA) Obstetrics and Gynecology Branch
❖ Standing Committee Member of the 2nd, 3rd and 4th Chinese Medical Association (CMA) Gynecologic Oncology Branch
❖ Deputy Group Leader of the Gynecologic Oncology Group, CMA Oncology Branch
❖ Standing Committee Member of the Gynecology Branch of the Chinese Geriatric Medical Association
Responsible Editor: Lily