# Advances in Screening, Immunotherapy, Targeted Agents, and Precision Surgery in Cervical Cancer: A Comprehensive Clinical Review (2018–2025)

## TL;DR

This review highlights recent advances in cervical cancer treatment, including precision medicine, immunotherapy, and improved surgical techniques, aiming to improve outcomes and global elimination efforts.

## Contribution

The paper provides a comprehensive clinical review of cervical cancer advancements from 2018 to 2025, emphasizing precision medicine and new therapeutic strategies.

## Key findings

- Precision screening methods like HPV genotyping and liquid biopsy are improving early detection and global elimination goals.
- Immunotherapy with pembrolizumab plus chemoradiation is now a curative standard for locally advanced cervical cancer.
- Emerging biomarkers such as PD-L1 and methylation classifiers are guiding treatment selection and surveillance.

## Abstract

Cervical cancer care treatment has rapidly evolved over the past decade. Personalized therapy, as opposed to one-size-fits-all, has revolutionized cervical cancer. In this review, we summarize key advances that further shape precision management, including biomarkers to guide therapy, personalized surgical treatment, and the expanding use of immunotherapy and targeted agents. We describe how tumor genomics, PD-L1 expression, HPV-related pathways, and emerging molecular signatures are changing treatment selection and improving patient outcomes. The goal of this review is to provide a clear and up-to-date overview of how precision medicine is transforming the diagnosis, treatment, and future clinical direction of cervical cancer.

Cervical cancer remains a significant global health burden, disproportionately affecting women in low- and middle-income countries despite being preventable. Since 2018, rapid advances in molecular profiling, immunotherapy, refinement of minimally invasive surgery, and targeted therapeutics have transformed diagnostic and therapeutic paradigms. This narrative review synthesizes clinical and translational progress across the continuum of care from 2018 to 2025. We summarize the evolving landscape of precision screening—including HPV genotyping, DNA methylation assays, liquid biopsy, and AI-assisted cytology—and discuss their implications for global elimination goals. Surgical management has shifted toward evidence-based de-escalation with data from SHAPE, ConCerv, and ongoing RACC informing fertility preservation and minimally invasive approaches. For locally advanced disease, KEYNOTE-A18 establishes pembrolizumab plus chemoradiation as a new curative standard, while INTERLACE underscores the benefit of induction chemotherapy. In the metastatic setting, survival outcomes have improved with the integration of checkpoint inhibitors (KEYNOTE-826, BEATcc, EMPOWER-Cervical 1), vascular-targeted therapies, and antibody–drug conjugates, including tisotumab vedotin and emerging HER2 and TROP-2–directed agents. We further highlight emerging biomarkers—PD-L1, TMB, MSI status, HPV integration patterns, APOBEC signatures, methylation classifiers, ctHPV-DNA—and their evolving role in treatment selection and surveillance. Future directions include neoadjuvant checkpoint inhibition, PARP-IO combinations, HER3-directed ADCs, DDR-targeted radiosensitizers, HPV-specific cellular therapies, and AI-integrated precision medicine. Collectively, these advances are reshaping cervical cancer care toward biologically individualized, globally implementable strategies capable of accelerating WHO elimination targets.