First-Line Treatment for Metastatic or Recurrent Unresectable Squamous Cell Carcinoma of the Vulva

When squamous cell carcinoma of the vulva presents as metastatic disease or recurs in a form that cannot be surgically removed, a systemic first-line approach is indicated. The protocol below addresses this specific clinical scenario.

Clinical scenario: Metastatic or recurrent unresectable squamous cell carcinoma of the vulva — a stage at which locoregional therapy alone is insufficient and systemic treatment becomes the primary strategy.

Treatment approach

Platinum-based combination chemotherapy is recommended as the first-line systemic treatment in this setting. Depending on tumour characteristics, additional agents may be considered for selected patients alongside the platinum backbone. The complete regimen options, selection criteria, and sequencing are detailed in the full protocol.

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References

Platinum-based combination chemotherapy should be considered as first-line treatment for metastatic or recurrent unresectable disease [III, B].

Although the best combination partner for platinum is unclear, cisplatin or carboplatin and paclitaxel could be considered the preferred regimen [IV, C].

Based on cervical cancer data, the addition of pembrolizumab in cases with PD-L1 expression with CPS≥1 and/or bevacizumab to platinum-based chemotherapy may be considered for selected patients in first line, although these drugs do not have specific approval for vulvar cancer [IV, C].

DOI: 10.1136/ijgc-2023-004486

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