What chemotherapy regimen would you utilize for a metastatic, poorly differentiated carcinoma of the cervix with neuroendocrine features?

I would work with pathology to define if this is a true neuroendocrine cervical cancer versus a poorly differentiated cervical carcinoma with neuroendocrine features. This could potentially impact treatment decisions. I treat patients with poorly differentiated metastatic cervical carcinoma with the GOG 240 regimen of carboplatin, paclitaxel, and bevacizumab (if no prior cisplatin-XRT, I use cisplatin rather than carboplatin). Conversely, if this is a true neuroendocrine (small cell) cervical carcinoma, I will try and use the approved regimen in small cell lung cancer - carboplatin, etoposide, plus atezolizumab. Lastly, I would advocate for tumor testing as a small proportion of neuroendocrine cervical cancer patients can be MSI-H with repo...

In the absence of high quality data for small cell carcinoma of the cervix, I'd use a regimen similar to small cell ca of the lung: carboplatin/etoposide or cisplatin/etoposide.

To compare with NET tumors, I wonder if anyone checks Ki67% to base decisions on this value?