New Standard of Care With Pembrolizumab and CRT in Cervical Cancer

Long-term findings from the KEYNOTE-A18 study (NCT04221945) confirm that adding pembrolizumab (Keytruda) to concurrent chemoradiation (CCRT), followed by pembrolizumab maintenance, significantly improves survival outcomes for patients with newly diagnosed, high-risk locally advanced cervical cancer.

Presented at the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting, the final analysis with a median follow-up of 41.9 months showed a 28% reduction in the risk of progression or death (PFS HR, 0.72) and a 27% reduction in the risk of death (OS HR, 0.73) with the pembrolizumab regimen compared to CCRT alone. At 36 months, 81.8% of patients in the pembrolizumab arm were alive vs 74.4% in the placebo arm. This benefit was consistent across most subgroups, with a manageable safety profile aligned with known effects of the individual treatments.

These compelling results establish pembrolizumab plus CCRT as the new standard of care for this patient population. In an interview with Targeted Oncology^TM, Linda Duska, MD, FASCO, MPH, director of the clinical trials program in gynecologic oncology and vice chair for research for the Department of Obstetrics and Gynecology at the University of Virginia Health, discusses the importance of these findings and the main takeaways from the research.

This new standard of care is transformative for this patient group, yet it's crucial to acknowledge the persistent importance of radiation in managing this disease. The study focused on delivering high-quality radiation, utilizing the most advanced techniques, including brachytherapy, at a predominantly high-dose rate.

Despite the challenges of a pandemic, Duska adds, 75% of patients completed their radiation within 56 days, a testament to the quality of care provided. Additionally, the median of 5 cycles of cisplatin during radiation met the standard of care.

Duska reinforces that high-quality chemoradiation is indispensable for positive outcomes in this disease. Unfortunately, its consistent delivery remains a challenge in the United States, partly because of its demanding adverse effects. Patients undergoing this treatment require substantial support, including frequent check-ins and diligent management of issues like nausea and dehydration. To truly optimize patient success with this regimen, high-quality chemoradiation must be seamlessly integrated with immunotherapy, Duska says.