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Adding immunotherapy to curative chemoradiation for locally advanced cervical cancer improved both control and survival, the first such advance in two decades.
KEYNOTE-A18, also ENGOT-cx11 and GOG-3047, trial NCT04221945 sponsored by Merck and published in the Lancet in 2024, showed that adding pembrolizumab to curative cisplatin chemoradiation and brachytherapy for high-risk locally advanced cervical cancer improves both disease control and survival, the first such advance in two decades. It randomised 1,060 patients, met its primary progression-free survival endpoint at 24 months and its overall survival endpoint at 36 months, and led to FDA approval in January 2024 for FIGO 2014 stage III to IVA disease, the first change to the cisplatin-radiation standard set in 1999. CALLA with durvalumab was negative, so the benefit is not yet reproduced with another agent, and why the two trials diverged is the open question.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
1,060 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Progression-free survival at 24 monthsprimary | Pembrolizumab + CRT | 529 | 68% | 0.7 (0.55 to 0.89) | - | link |
| Placebo + CRT | 531 | 57% | ||||
| Overall survival at 36 monthsprimary | Pembrolizumab + CRT | - | 82.6% | 0.67 (0.5 to 0.9) | - | link |
| Placebo + CRT | - | 74.8% |
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 Bradley J. Monk, Locally advanced cervical cancer, Cervical cancer, Cisplatin.
Shares Bradley J. Monk, Vaginal cancer, PD-1, Cervical cancer.
Shares Locally advanced cervical cancer, Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH, Brachytherapy, Cervical cancer.
Shares Society of Gynecologic Oncology, GOG Foundation, PD-1, Pembrolizumab.
Shares Locally advanced cervical cancer, Brachytherapy, Cervical cancer, IMRT / IGRT (modern external beam).
Shares Locally advanced cervical cancer, Cervical cancer, Cisplatin, Immune checkpoint inhibitors.
Shares GOG Foundation, PD-1, Pembrolizumab, Immune checkpoint inhibitors.
Shares GOG Foundation, Locally advanced cervical cancer, Cervical cancer, IMRT / IGRT (modern external beam).