Pembrolizumab binds to the PD1 receptor blocking its interaction with PDL1 and PDL2, releasing PD1 pathway-mediated inhibition of the immune response. It is not currently licensed for use in cervical cancer anywhere in Europe. It was granted approval by the FDA in 2018 for treatment of patients with recurrent or metastatic cervical cancer with progression on or after chemotherapy whose tumours express PDL1 CPS ≥1, based on the interim results from Keynote 158. This showed an ORR of 14.6% in PDL1+ population. The aim of this project was to assess our experience with pembrolizumab in patients with advanced cervical cancer in our hospital setting.
Patients with advanced cervical cancer treated with pembrolizumab at 3 hospitals in Ireland were included. Key clinical data was collected from hard copy and electronic medical records. All patients had recurrent or metastatic cervical cancer. Patients received Pembrolizumab 200mg IV once every three weeks. We analysed PFS, OS and ORR.
Data collection was between April 2018 and December 2019. Baseline characteristics include: median age 41 (27-77yrs), 95% FIGO stage IVB, 5% stage IIIB. Histology: 70% SCC, 20% adenocarcinoma, 5% mixed large/small cell, 5% unknown. PDL1 status: 50% positive, 30% unknown, 20% negative. 90% had received previous systemic treatment in the metastatic setting. The ORR was 25% with a DCR of 30%. All responses were in patients with PDL1+ or of unknown PDL1 status. mOS was 8.9months in total population (11.2months in PDL1+), and mPFS was 6.4months (8.3months in PDL1+). 45% of patients experienced all grade toxicity with 10% experiencing grade 3-4.
The observed activity in our patient population is superior to the interim results from Keynote 158. There are limited therapeutic options in these symptomatic and often terminally ill patients. Additionally, all of these alternate treatments create a significant toxicity profile impacting hugely on the patients’ quality of life. Therefore, in our real-life experience, pembrolizumab provides an effective and much improved toxicity profile alternative in this patient population. We believe, based on our findings, pembrolizumab should be considered as a standard option for those with advanced PDL1+ cervical cancer.
Legal entity responsible for the study
Has not received any funding.
The author has declared no conflicts of interest.