Dr. Casablanca on the Integration of Pembrolizumab in Recurrent or Metastatic Cervical Cancer

Yovanni Casablanca, MD, colonel, Air Force, program director, Fellowship in Gynecologic Oncology, National Capital Consortium, associate professor, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University School of Medicine, discusses the integration of pembrolizumab (Keytruda) into the paradigm of recurrent or metastatic cervical cancer.

The standard of care for patients with recurrent or metastatic cervical cancer was paclitaxel plus cisplatin or carboplatin with or without bevacizumab (Avastin), Casablanca says. However, in October 2021, the FDA approved pembrolizumab for use with that combination in patients with persistent, recurrent, or metastatic cervical cancer whose tumors express PD-L1 by combined positive score of at least 1. The FDA also granted regular approval to single-agent pembrolizumab for patients with PD-L1–positive, recurrent, or metastatic cervical cancer with disease progression on or after chemotherapy.

The approval was based on findings from the phase 3 KEYNOTE-826 trial (NCT03635567), which demonstrated that the median overall survival was not reached in PD-L1–positive patients treated with the pembrolizumab and chemotherapy (with or without bevacizumab) regimen vs 16.3 months with chemotherapy (with or without bevacizumab) and a placebo.

With this paradigm change, eligible patients with cervical cancer can receive a 4-drug regimen compared with a 3-drug regimen; however, PD-L1 testing is critical to identify appropriate patients for pembrolizumab, Casablanca concludes.