Keytruda (Pembrolizumab) with Chemoradiotherapy in Locally Advanced Cervical Cancer: What the KEYNOTE-A18 Trial Showed
The Lancet has published the results of the second interim analysis of KEYNOTE-A18 in patients with newly diagnosed high-risk locally advanced cervical cancer. The trial compared chemoradiotherapy with the addition of Keytruda (pembrolizumab) versus chemoradiotherapy with placebo. Adding pembrolizumab improved overall survival.
In brief: what happened
The trial enrolled 1,060 patients: 529 in the Keytruda arm and 531 in the placebo arm. The median follow-up was 29.9 months.
- 36-month overall survival was 82.6% in the pembrolizumab arm and 74.8% in the placebo arm.
- Grade 3 and higher adverse events were observed in 78% and 70% of patients, respectively.
Key numbers from the trial
The risk of death was reduced by 33% (HR 0.67; 95% CI 0.50–0.90; p=0.0040). Median overall survival was not reached in either arm. Potentially immune-mediated adverse events were noted in 39% of patients on pembrolizumab and in 17% in the control group.
Why this matters in practice
In high-risk locally advanced cervical cancer, chemoradiotherapy has long remained the foundation of treatment. KEYNOTE-A18 shows that immunotherapy can be added to this standard to achieve a benefit in overall survival.
Limitations / what is not changing yet
This trial concerns high-risk locally advanced disease (FIGO stage IB2–IIB with lymph node involvement, or III–IVA). These data do not apply to early operable stages and do not apply to recurrent or metastatic disease.
When a second opinion is especially useful
- the stage is in doubt;
- different centers offer different radical treatment regimens;
- you want to understand whether the immuno-chemoradiotherapy option is right for you;
- it is important to assess the balance between efficacy and toxicity.
What to prepare for the consultation
- histopathology report;
- pelvic MRI;
- CT or PET-CT, if performed;
- discharge summary with the FIGO stage and treatment plan;
- blood tests and biochemistry;
- list of comorbidities and medications.
Frequently Asked Questions
Is this regimen suitable for all patients with cervical cancer?
No. KEYNOTE-A18 studied only high-risk locally advanced disease.
Does this treatment replace radiotherapy?
No. Radiotherapy and cisplatin remain the foundation, and pembrolizumab is added to this standard.
Was toxicity higher?
Yes, severe adverse events and immune-mediated reactions were observed more often, so careful monitoring is needed.
More answers on the FAQ page.