Invited discussant Krishnansu Tewari, MD, Associate Professor in the Division of Gynecologic Oncology at the University of California, Irvine, said two new approaches for locally advanced cervical cancer, as described at the European Society for Medical Oncology (ESMO) Congress 2023, represent long-awaited improvements. After a series of negative or otherwise disappointing trials, he said, “this year at ESMO, we heard two remarkable studies.”
Krishnansu Tewari, MD
Along with the positive INTERLACE trial, which showed a significant progression-free and significant overall survival benefit, KEYNOTE-A18 demonstrated a progression-free survival benefit and a trend favoring overall survival with pembrolizumab integrated into the chemoradiotherapy regimen. The inclusion of checkpoint blockade significantly improved progression-free survival rates at 2 years (68% vs 57% with placebo; hazard ratio [HR] = 0.70; P = .002), according to Lorusso and colleagues.1
“We are ready for a paradigm shift,” Dr. Tewari said. The question now is how to incorporate and optimize these two different approaches, he said. “How do we integrate the KEYNOTE-A18 study into locally advanced cervical cancer treatment? Should we await mature overall survival data, or should we consider adopting it based on a [PD-L1 combined positive score] ≥ 1? Or should we combine INTERLACE with KEYNOTE-A10 and do induction chemotherapy followed by chemoradiation plus brachytherapy with pembrolizumab followed by pembrolizumab as maintenance. These questions are important to consider.”
DISCLOSURE: Dr. Tewari reported financial relationships with AbbVie, AstraZeneca, Eisai, GSK, ImmunoGen, Karyopharm, Merck, Morphotek, Regeneron, Roche/Genentech, and Seagen/Genmab.
REFERENCE
1. Lorusso D, Xiang Y, Hasegawa K, et al: Pembrolizumab plus chemotherapy for high-risk locally advanced cervical cancer: The randomized, double-blind, phase 3 ENGOT-cx11/GOG-3047/KEYNOTE-A18 study. ESMO Congress 2023. Abstract LBA38. Presented October 20, 2023.
