Topical vaginal drug therapy in cervical cancer management: a review of clinical trials and preclinical evidence.

Cervical cancer, the fourth most prevalent malignancy among women globally, is predominantly caused by persistent infection with high-risk human papillomavirus (HPV). Traditional methods such as surgery and chemotherapy are often associated with high incidence of adverse effects and may impact future pregnancies and childbirth especially for young female patient. Given that high-risk HPV primarily targets epithelial cells and cervical lesions are mainly localized in the cervix, local administration in the cervicovaginal area emerges as one of the most direct and effective methods for treating cervical cancer and its precursors. Topical vaginal administration not only minimizes systemic drug exposure but also simplifies application, reduces treatment costs, and supports fertility preservation. Nevertheless, there are currently no official recommendations for local therapies targeting HPV eradication or tumor lesion treatment. This review focuses on clinical trials and preclinical studies related to local pharmacotherapy for cervical tumors, with an emphasis on evaluating the efficacy of local treatments aimed at preventing the progression of cervical intraepithelial neoplasia. It encompasses therapeutic agents, clinical efficacy and adverse effects, treatment strategies, and innovations in formulations while also addressing the inherent challenges of vaginal administration and predicting future trends in this therapeutic field. Clinical studies have shown that trichloroacetic acid offers the best patient compliance and therapeutic response, although concerns remain regarding its uncontrolled depth of tissue penetration. In parallel, formulation optimization strategies such as prolonging vaginal residence time and employing nanotechnology to enhance drug loading and targeted delivery have shown promise in improving therapeutic outcomes.