The KEYNOTE-826 trial established immunotherapy in cervical carcinoma. In which patient population was pembrolizumab shown to improve overall survival when added to chemotherapy (carboplatin/paclitaxel ± bevacizumab)?
- A Stage IIB–IVA cervical cancer receiving concurrent chemoradiation
- B Recurrent/metastatic cervical cancer with PD-L1 CPS ≥1 ✓
- C Adjuvant therapy for stage IB2 cervical cancer post-radical hysterectomy
- D Recurrent cervical cancer with BRCA1/2 mutation
Explanation
The KEYNOTE-826 trial (NEJM 2021) enrolled patients with persistent, recurrent, or metastatic cervical cancer not amenable to curative therapy. Pembrolizumab (PD-1 inhibitor) added to chemotherapy ± bevacizumab significantly improved both progression-free survival and overall survival. Benefit was observed in the PD-L1 CPS ≥1 population, and the greatest benefit was in PD-L1 CPS ≥10. FDA approved pembrolizumab for first-line treatment of persistent/recurrent/metastatic cervical cancer with PD-L1 CPS ≥1. This represents a major shift in management. The concurrent chemoradiation setting is being explored in separate trials (CALLA trial with durvalumab). BRCA mutations are not the basis for immunotherapy benefit in cervical cancer.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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