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Because cervical tumours carry viral DNA that normal cells do not, a blood test for HPV DNA is a near-perfect tumour marker for tracking response and relapse.
Cervical tumours carry HPV DNA that normal cells do not, so a blood test for HPV ctDNA is a near-perfect tumour marker, and this idea would use it to steer therapy. Plasma HPV ctDNA measured by droplet digital PCR or sequencing is detectable in most locally advanced cases, falls during chemoradiation, and predicts relapse months before imaging, as shown by Cabel, Han and others. The hypothesis is that persistent HPV ctDNA at the end of chemoradiation identifies the patients who benefit from adjuvant pembrolizumab, while undetectable ctDNA allows maintenance to be omitted. The rationale is a tumour-specific analyte with zero background measured by cheap PCR, which would make the KEYNOTE-A18 benefit affordable; the test is a ctDNA-stratified randomised trial, at an early clinical stage.
The survival gain turns the earlier progression-free survival result into a clear reason to offer pembrolizumab with and after chemoradiotherapy to women with node-positive or stage III-IVA cervical cancer. Because cervical cancer is concentrated in low- and middle-income countries, the benefit reaches most women only if pricing and access follow.
Women with locally advanced cervical cancer that is node-positive or stage III-IVA can be offered pembrolizumab alongside and after chemoradiotherapy to lower the chance of relapse. The result matters most in countries where cervical cancer is common but immunotherapy access is poorest, so its global impact depends on pricing and health-system capacity. It does not apply to early-stage disease treated with surgery or to lower-risk locally advanced disease without nodal involvement.
Shares KEYNOTE-A18 / ENGOT-cx11 / GOG-3047, KEYNOTE-A18: pembrolizumab with chemoradiotherapy for locally advanced cervical cancer (overall survival), KEYNOTE-A18: pembrolizumab with chemoradiotherapy for locally advanced cervical cancer (progression-free survival), Cervical cancer.
Shares KEYNOTE-A18 / ENGOT-cx11 / GOG-3047, Locally advanced cervical cancer, Cervical cancer, Pembrolizumab.
Shares Minimal / molecular residual disease (MRD), Circulating tumour DNA (ctDNA), MRD / molecular residual disease testing, Liquid biopsy (ctDNA).
Shares Minimal / molecular residual disease (MRD), Circulating tumour DNA (ctDNA), MRD / molecular residual disease testing, Liquid biopsy (ctDNA).
Shares Minimal / molecular residual disease (MRD), Circulating tumour DNA (ctDNA), MRD / molecular residual disease testing, Liquid biopsy (ctDNA).
Shares Early cervical cancer and fertility-sparing surgery, Recurrent or metastatic cervical cancer, Cervical cancer, Pembrolizumab.
Shares Minimal / molecular residual disease (MRD), Circulating tumour DNA (ctDNA), MRD / molecular residual disease testing, Liquid biopsy (ctDNA).
Shares Minimal / molecular residual disease (MRD), Circulating tumour DNA (ctDNA), MRD / molecular residual disease testing, Liquid biopsy (ctDNA).