International Journal of Clinical Case Reports, 2025, Vol.15, No.3, 139-147 http://medscipublisher.com/index.php/ijccr 144 blood pressure. About 23% had too much protein in their pee, and 6% got holes in their intestines (Gopu et al., 2021). Pembrolizumab can also bring problems. It makes the immune system too active and may harm healthy parts of the body. Some people had low thyroid levels, gut swelling, or trouble with their lungs. In the KEYNOTE-158 trial, 16% of patients had these types of side effects. Around 7% had to stop using the drug because the side effects were too strong (Mauricio et al., 2021). Doctors should keep an eye on these problems and treat them early, so patients can keep getting their treatment. 5.3 Resistance mechanisms Sometimes cancer stops responding to drugs. This is called resistance. It's a big issue. Tumors can avoid chemo by fixing their DNA better, pushing drugs out, or not dying like they should. For example, cisplatin may stop working if the tumor gets better at repairing itself (Regalado et al., 2018). Targeted drugs like bevacizumab can also stop working after a while. The tumor might find another way to grow blood vessels, such as using FGF instead of VEGF. This lets it keep growing even with treatment (Liontos et al., 2019). Using a mix of drugs, like pembrolizumab and bevacizumab together, could help block more of these backup paths and make the treatment last longer (Mauricio et al., 2021). 5.4 Accessibility and cost Combo therapies are very pricey. That makes them hard to get, especially in lower-income countries. Drugs like bevacizumab and pembrolizumab can cost over $100 000 a year for one person. That’s a big burden for health systems and insurance (Porras et al., 2018). These areas also have more people with cervical cancer, but their healthcare is often not as good. Hospitals might not have enough doctors, nurses, or tools to give treatment or watch for side effects. This makes it even harder for patients to get help (Yang et al., 2022). To fix this, we need cheaper treatments and stronger healthcare systems in these places. 6 Future Directions 6.1 Emerging targeted agents Doctors are trying new targeted drugs to treat cervical cancer. These drugs focus on how cancer cells grow. One group is called PARP inhibitors. A drug named olaparib is one of them. It makes it harder for cancer cells to fix their damaged DNA. This helps chemo work better. There’s also a medicine called tisotumab vedotin. It links a chemo drug with an antibody. This helps the drug go directly to the cancer cells and causes less harm to healthy ones (Wilson et al., 2024). Another new idea is using bispecific antibodies. These can block two targets at the same time. For example, some can block VEGF and HER2. This may help stop the cancer from coming back and make treatment work better (Ji, 2020). These new drugs could be used with older ones to help more people. 6.2 Immunotherapy and chemotherapy combinations Using immune drugs together with chemo is another new method to treat cervical cancer. Medicines like pembrolizumab and nivolumab help the body’s defense system find and attack the cancer. They stop the PD-1/PD-L1 path, which normally lets the cancer stay hidden (Mauricio et al., 2021). Lab studies show this combo brings more killer T cells to the tumor. It also cuts down cells that stop the immune system (Sherer et al., 2022). Some doctors now test the tumor first to choose the best immune drug for each person. This custom plan may work even better (Cohen et al., 2020). 6.3 Overcoming resistance Sometimes, cancer stops responding to treatment. This is called drug resistance. It’s a big challenge. But new ways might help.
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