Improving survival from metastatic, recurrent, or persistent cervical cancer

Cervical cancer is a major cause of death and morbidity worldwide, and prognosis remains poor in those with advanced disease. 1 Sung H Ferlay J Siegel RL et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71: 209-249 Crossref PubMed Scopus (42826) Google Scholar We welcome the publication in The Lancet of the BEATcc trial (ENGOT-Cx10–GEICO 68-C–JGOG1084–GOG-3030), which shows a significant survival advantage from adding an immune checkpoint inhibitor to standard-of-care therapy. 2 Oaknin A Gladieff L Martínez-García J et al. Atezolizumab plus bevacizumab and chemotherapy for metastatic, persistent, or recurrent cervical cancer (BEATcc): a randomised, open-label, phase 3 triall. Lancet. 2023; (published online Dec 1.)https://doi.org/10.1016/S0140-6736(23)02405-4 Google Scholar Previously, the phase 3 Gynaecologic Oncology Group 240 trial established chemotherapy in combination with bevacizumab as standard first-line treatment for incurable cervical cancer, with a median overall survival of approximately 17 months. 3 Tewari KS Sill MW Penson RT et al. Bevacizumab for advanced cervical cancer: final overall survival and adverse event analysis of a randomised, controlled, open-label, phase 3 trial (Gynecologic Oncology Group 240). Lancet. 2017; 390: 1654-1663 Summary Full Text Full Text PDF PubMed Scopus (351) Google Scholar The Keynote-826 trial produced compelling evidence supporting the use of immune checkpoint inhibitors, specifically PD-1 inhibitors, in metastatic cervical cancer. Keynote-826 was a phase 3 trial exploring the addition of pembrolizumab to first-line chemotherapy (with or without bevacizumab at physician discretion) and showed a significantly improved overall survival of 26·4 months versus 16·8 months (hazard ratio [HR] 0·63 95% CI 0·52–0·77) in their all-comer population. 4 Monk BJ Colombo N Tewari KS et al. First-line pembrolizumab + chemotherapy versus placebo + chemotherapy for persistent, recurrent, or metastatic cervical cancer: final overall survival results of KEYNOTE-826. J Clin Oncol. 2023; (published online Nov 1.)https://doi.org/10.1200/JCO.23.00914 Crossref Google Scholar The greatest benefit was seen in the PD-L1 positive (≥1 combined positive score) cohort, with the Keynote-826 data leading to pembrolizumab plus chemotherapy being approved in many countries, in some instances only for patients who are PD-L1 positive. Atezolizumab plus bevacizumab and chemotherapy for metastatic, persistent, or recurrent cervical cancer (BEATcc): a randomised, open-label, phase 3 trialAdding atezolizumab to a standard bevacizumab plus platinum regimen for metastatic, persistent, or recurrent cervical cancer significantly improves progression-free and overall survival and should be considered as a new first-line therapy option. Full-Text PDF