Low-Dose Metronomic Chemotherapy With Fixed Low-Dose Nivolumab for Recurrent Cervical Cancer After Radiotherapy: Experience From Routine Clinical Practice.

Background Recurrent cervical cancer following definitive radiotherapy remains a difficult clinical problem, particularly in low- and middle-income countries. Although immune checkpoint inhibitors have shown activity in this setting, their cost and prolonged treatment duration limit real-world accessibility. Strategies that retain biological activity while improving affordability are therefore needed. Methods We conducted a retrospective review of 21 patients with recurrent cervical cancer previously treated with radiotherapy or chemoradiotherapy. Patients received a fixed low dose of nivolumab (20 mg intravenously every two weeks) combined with metronomic oral chemotherapy using either methotrexate or capecitabine. Clinical outcomes included progression-free survival, overall survival, response rates, and toxicity. Results The overall response rate was 38%, seen in eight patients, and disease control was achieved in 14 (67%). Median progression-free survival was approximately 8.6 months, and median overall survival was about 15 months. One-year and two-year overall survival rates were 61% and 42%, respectively. Treatment was generally well tolerated, with mostly grade 1/2 adverse events and no treatment-related deaths. Conclusion Low-dose nivolumab combined with metronomic chemotherapy appears to be a reasonable and pragmatic option for selected patients with recurrent cervical cancer, particularly in settings where access to standard immunotherapy is limited. These observations support further prospective evaluation.