The KEYS trial (2022) evaluated the addition of pembrolizumab (anti-PD1) to chemoradiation in locally advanced cervical cancer. What was the primary finding of this phase III trial?

• A Pembrolizumab improved overall survival but not progression-free survival
• B Pembrolizumab reduced local recurrence only in PD-L1 positive tumours
• C Pembrolizumab showed benefit only in squamous cell carcinoma, not adenocarcinoma
• D Pembrolizumab added to concurrent cisplatin-based chemoradiation significantly improved progression-free survival at 24 months ✓

Explanation

The KEYNOTE-A18 (ENGOT-cx11/GOG-3047) trial (2023) — also referred to as the KEYS trial — demonstrated that pembrolizumab added to cisplatin-based chemoradiation followed by pembrolizumab maintenance significantly improved progression-free survival (PFS) at 24 months (hazard ratio 0.70, p=0.0020) in locally advanced cervical cancer (FIGO 2014 stage IB2–IVA). This was a landmark trial that led to FDA approval of pembrolizumab for this indication. The benefit was seen across all PD-L1 expression levels, not restricted to PD-L1 positive or specific histologies.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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