Evaluating the benefits of immunotherapy in metastatic cervical cancer: an observational retrospective analysis

Abstract Background Cervical cancer is the fourth most commonly diagnosed cancer and the fourth leading cause of cancer-related death in women globally. Recent advances in immunotherapy have demonstrated promising results. This study analyses the real-world impact of adding immunotherapy for patients with stage IV cervical carcinoma. Material and methods This longitudinal retrospective observational study included patients with stage IV cervical carcinoma in the first metastatic setting treated between 2010 and 2023 at the University Hospital Nuestra Señora de Candelaria in Tenerife, Spain. To evaluate the primary objective, patients were divided into two groups depending on whether they had received immunotherapy with pembrolizumab or not. The primary endpoint was 12-month progression-free survival in patients receiving immunotherapy compared to those not receiving it. Results A total of 56 patients were analyzed, of whom 31 were tested for PD-L1. Among those tested, 25 patients (84%) were PD-L1 positive, and 18 of them (72%) received immunotherapy. The objective response rate was significantly higher, being 94% in the group that received immunotherapy, compared to 32% in the group that did not ( p < 0.001). At 12 months, the cumulative probability of progression-free survival was estimated at 94.4% for the immunotherapy group versus 59.7% in the non-immunotherapy group ( p = 0.009), with a hazard ratio of 0.116 (CI 95% : 0015 – 0.883; p = 0.038). Immunotherapy alone or combined with bevacizumab showed similar progression-free survival probabilities. However, these outcomes were significantly different when compared to patients who received neither therapy ( p < 0.001). Conclusions Our findings confirm that immunotherapy significantly improves progression-free survival and objective response rates in metastatic cervical carcinoma, aligning with the results from the KEYNOTE-826 trial. The implementation of PD-L1 testing and the addition of immunotherapy whenever possible are challenges to be achieved in clinical practice.