Pembrolizumab with chemotherapy, with or without bevacizumab for persistent, recurrent, or metastatic cervical cancer

ABSTRACT

Introduction

Despite progress on prevention and treatment of cervical cancer, global morbidity and mortality remain high. Immunotherapy, in conjunction with standard chemotherapy, presents an opportunity for further benefit.

Areas covered

Here we report the pharmacologic properties, evidence for clinical efficacy, safety, and tolerability of pembrolizumab in addition to standard chemotherapy with and without bevacizumab for treatment of advanced or recurrent cervical cancer.

Expert opinion

In patients with progressive, recurrent, or metastatic PD-L1 expressing cervical cancer, without contraindication to anti-VEGF therapy, the use of pembrolizumab with bevacizumab and standard chemotherapy with carboplatin and paclitaxel is warranted. There is no evidence to support the use of pembrolizumab for this population broadly, and no evidence to support its use in PD-L1 non-expressing tumors.

KEYWORDS:

• Cervical cancer
• immune checkpoint inhibitor
• PD-1
• pembrolizumab
• bevacizumab

Article highlights

• Pembrolizumab is a humanized monoclonal immunoglobulin G4/kappa isotype antibody against the programmed cell death-1 (PD-1) receptor.

• Bevacizumab, is a recombinant human monoclonal immunoglobulin G1 (IgG1) antibody against vascular endothelial growth factor (VEGF), leading to inhibition of tumor angiogenesis.

• The combination of pembrolizumab and bevacizumab has a favorable safety profile and promising preliminary data in patients with recurrent or metastatic cervical cancer with CPS score ≥1.

• The expense of both agents may limit their global uptake as standard of care treatments in this setting.

Declaration of interest

A Santin reports grants from Puma, grants from Immunomedics, grants from Gilead, grants from Synthon, grants and personal fees from Merck, grants from Boehringer-Ingelheim, grants from Genentech, grants and personal fees from Tesaro, and grants and personal fees from Eisai. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• Pembrolizumab is a humanized monoclonal immunoglobulin G4/kappa isotype antibody against the programmed cell death-1 (PD-1) receptor.

• Bevacizumab, is a recombinant human monoclonal immunoglobulin G1 (IgG1) antibody against vascular endothelial growth factor (VEGF), leading to inhibition of tumor angiogenesis.

• The combination of pembrolizumab and bevacizumab have a favorable safety profile and promising preliminary data in patients with recurrent or metastatic cervical cancer with CPS score ≥1.

• The expense of both agents may limit their global uptake as standard of care treatments in this setting.

Additional information

Funding

This paper was not funded.