Abstract
The prognosis for patients with recurrent or metastatic cervical cancer (r/mCC) remains challenging, with a 5-y survival rate of approximately 17%. Although first-line treatment has evolved from traditional single-agent chemotherapy to combination regimens that incorporate targeted therapy and immunotherapy-showing improved initial response rates - therapeutic options after disease progression remain limited and often yield suboptimal outcomes. Ivonescimab, the first tetravalent bispecific monoclonal antibody capable of simultaneously targeting programmed death receptor-1 (PD-1) and vascular endothelial growth factor A (VEGF-A), demonstrates robust anti-tumor activity and a manageable safety profile across various solid tumors through synergistic blockade of both immune checkpoint pathways and tumor angiogenesis. This case report describes a patient diagnosed with cervical squamous cell carcinoma accompanied by hepatic metastases who received first-line therapy with platinum-based chemotherapy in combination with cadonilimab and bevacizumab. According to RECIST 1.1 criteria, a partial response (PR) was achieved after four treatment cycles, with a PFS of 11 months. Subsequent to disease progression, second-line treatment was initiated with ivonescimab combined with single-agent albumin-bound paclitaxel. After two treatment cycles, PR was achieved, and the patient continues to derive clinical benefits. Throughout the treatment course, the patient experienced only low-grade adverse events (CTCAE grade 1 or below) and maintained a satisfactory quality of life. To our knowledge, this is the first reported case demonstrating a significant response to ivonescimab in recurrent or metastatic cervical cancer following failure of first-line immunotherapy combined with anti-angiogenic therapy. This case preliminarily validates its anti-tumor activity and safety characteristics, and presents a novel therapeutic strategy for later-line management.