Pembrolizumab for the treatment of cervical cancer

ABSTRACT

Introduction: The prognosis of patients with recurrent and/or metastatic cervical cancer remains poor, with a 5-year survival rate of 17%. Most of cervical cancers are associated with the human papillomavirus (HPV) infection that leads to viral antigens production, supporting the development of immunotherapy in cervical cancer.

Areas covered: Here we report the pharmacologic properties, clinical efficacy, and safety profile of pembrolizumab, an IgG4-kappa humanized monoclonal antibody against the programmed cell death protein 1 (PD-1) receptor, for the treatment of cervical cancer.

Expert opinion: Single agent pembrolizumab has limited efficacy in the recurrent and/or metastatic setting in an unselected patient population. However, durable responses in PD-L1-expressing cervical cancer patients led the U.S. Food and Drug Administration to grant accelerated approval of pembrolizumab in this patient population. Outside this patient population, further development involves combinations with other treatment options including chemotherapy, radiotherapy and other immunotherapeutic agents. The identification of biomarkers of efficacy beyond PD-L1 expression will be essential in order to identify patients who will most likely benefit from pembrolizumab.

KEYWORDS:

• Cervical cancer
• HPV
• immune checkpoint
• PD-1
• pembrolizumab

Box 1. Drug Summary.

Article Highlights

• Evidence-based data regarding cervical cancer and checkpoint blockade are scarce and preliminary.

• Pembrolizumab has been approved in PD-L1-positive cervical cancer patients based on sustained responses.

• Combinations of pembrolizumab with chemoradiation and in earlier disease stages are being evaluated.

The identification of biomarkers of efficacy beyond PD-L1 expression is urgently needed.

This box summarizes key points contained in the article.

Declaration of interest

C Le Tourneau has participated in advisory boards from BMS, MSD, Merck Serono, Amgen, GSK, Roche, Astra Zeneca, and Nanobiotix. 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 relationships or otherwise to disclose.

Additional information

Funding

This paper is not funded.