Clinical Advances in Hematology & OncologyUpdate on Immune Checkpoint Inhibition for Cervical Cancer

🎓 Expert Commentary / Peer Perspective

HPV drives more than 98% of cervical cancers, creating a biologically rational basis for immunotherapy. Pembrolizumab is now approved across locally advanced and recurrent/metastatic settings; approval criteria, PD-L1 requirements, and eligible populations differ meaningfully by indication.

Clinical Considerations

• KEYNOTE-A18 established pembrolizumab plus chemoradiotherapy for high-risk LACC (stage IB2–IVA): 3-year OS 82.6% vs 74.8% in PD-L1–expressing tumors at median 29.9-month follow-up, confirmed at 41+ months
• KEYNOTE-826 and BEATcc support first-line pembrolizumab or atezolizumab added to chemotherapy ± bevacizumab in recurrent/metastatic disease; most cervical cancers express PD-L1 by IHC
• INTERLACE patients had substantially lower-risk disease than KEYNOTE-A18 — combining induction chemotherapy with pembrolizumab is under study in NRG-GY037 but has no current evidence base
• ADCs, PARP inhibitors, and dual checkpoint combinations are in active investigation; phase 3 GOG-3123 is evaluating sacituzumab tirumotecan plus pembrolizumab as first-line maintenance

Practice Applications

• Match treatment regimen to disease stage and nodal status — INTERLACE and KEYNOTE-A18 populations are not interchangeable
• Recognize that PD-L1 testing requirements vary by indication — single-agent pembrolizumab in recurrent disease requires CPS ≥1; first-line combination data include PD-L1–unselected populations
• Consider at-home HPV sample collection options for patients with access barriers, particularly in rural settings
• Ensure adolescent HPV vaccination is addressed at every visit — cervical cancer remains an almost entirely preventable disease