Clinicopathologic and molecular aspects of high-grade neuroendocrine carcinoma of the uterine cervix: emphasis on novel chemotherapeutic strategies

High-grade neuroendocrine carcinomas (HGNEC) of the cervix are rare and carry an extremely poor prognosis. Fortunately, there have been recent advances in our molecular understanding of these carcinomas and some advances offer novel therapeutic options. The vast majority of HGNEC of the cervix are associated with human papillomavirus (HPV) and would be prevented by currently available vaccines. TP53 mutations are variably identified and likely drive a second pathway, one unrelated to high-risk HPV. Most carcinomas express VEGF and some patients have seen durable response to therapy with the addition of a VEGF inhibitor. PIK3CA mutations are among the most common mutations identified and mTOR inhibitors may be considered in these cases. KRAS mutations can be identified; an impressive response to MEK inhibitors has been seen in one case. PD-L1 positivity is frequently seen and complete responses to PD-1/PD-L1 inhibitors have been reported. These molecular advances offer numerous approaches to targeted personalized therapy.