This is a prospective, single-arm, phase II clinical study designed to evaluate the efficacy and safety of QL1706 combined with cisplatin and paclitaxel as neoadjuvant therapy in patients with FIGO 2018 stage IB1-IB3 cervical cancer undergoing conservative surgery.

The primary endpoint is pathological complete response (pCR). Secondary endpoints include objective response rate (ORR), progression-free survival (PFS), overall survival (OS), 3-year pelvic recurrence rate, and safety profile.

Additionally, exploratory biomarker analyses will be conducted to investigate changes in immune status, genomic alterations, PD-L1 expression, tumor mutational burden, MSI-H/dMMR status, and vaginal microbiota before and after treatment.

Cervical cancer remains one of the most common gynecologic malignancies worldwide. Neoadjuvant chemotherapy (NACT) has demonstrated favorable response rates in locally advanced cervical cancer; however, pathological complete response (pCR) rates remain limited.

QL1706 is a novel bifunctional PD-1/CTLA-4 antibody combination developed using the MabPair® platform. It consists of the anti-PD-1 antibody iparomlimab and the anti-CTLA-4 antibody tuvonralimab. Previous studies have demonstrated promising antitumor activity in recurrent or metastatic cervical cancer.

This study aims to investigate whether the addition of QL1706 to cisplatin/paclitaxel neoadjuvant therapy can improve pathological response and clinical outcomes in patients with FIGO 2018 stage IB1-IB3 cervical cancer undergoing conservative surgery.

Approximately 50 patients will be enrolled. Eligible patients will receive neoadjuvant QL1706 combined with cisplatin and paclitaxel followed by radical surgery. Efficacy will be evaluated using RECIST v1.1 and pathological assessment. Safety will be assessed according to CTCAE v5.0.

Exploratory translational studies will evaluate immune microenvironment changes, molecular biomarkers, and vaginal microbiota alterations associated with treatment response.

Inclusion Criteria:

• Female patients aged 18-65 years.
• Histologically confirmed cervical squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma.
• FIGO 2018 stage IB1, IB2, or IB3 cervical cancer.
• Pelvic MRI completed before enrollment.
• ECOG performance status of 0-2.
• Adequate organ and bone marrow function.
• No prior immunotherapy for malignant tumors.
• Ability to understand and willingness to sign written informed consent.

Exclusion Criteria:

• Presence of uncontrolled concomitant malignancies.
• Active autoimmune disease or history of autoimmune disease with potential recurrence.
• Interstitial lung disease or uncontrolled pneumonitis.
• Active hepatitis B or hepatitis C infection.
• Known HIV infection.
• Receipt of live vaccines within 30 days before first dose.
• Uncontrolled cardiovascular disease.
• Known hypersensitivity to study drugs.
• Any condition that, in the investigator's judgment, may interfere with study participation or interpretation of results.