The Case for Early Use of Immunotherapy Plus Radiation/Chemo for Patients With High-Risk Cervical Cancer

At the 2024 Great Debates and Updates in Women’s Oncology meeting in New York, New York, Bradley Monk, MD, FACOG, Florida Cancer Specialists & Research Institute, West Palm Beach, Florida argues for the first-line use of immune checkpoint inhibitors plus chemotherapy and radiation therapy for patients with cervical cancer.

Transcript:

Greetings, my name is Brad Monk, I'm a gynecologic oncologist practicing at Florida Cancer Specialists and I'm here at Great Debates in Women's Oncology. We had the opportunity to talk about immune therapy in cervical cancer, it's a no -brainer. First approved in June of 2018 in the second line in PDL1, then approved in 2021 with chemotherapy, with or without bevacizumab.

And now, as of January, we can add it to chemotherapy and radiation to potentially cure more patients. Now the challenge of the debate was should we do it because about 2/3 of the patients are cured anyway, with chemotherapy and radiation.

So if 2/3 of the patients are cured anyway, why do you need something like pembrolizumab, which is now FDA-approved, in the highest risk subset, the 2014 stage IIIs and IVs, which are the pelvic side [] hydronephrosis, bladder and rectal involvement groups? And that's the reason, because only 2/3 of the patients are cured. I contended that, yes, we should use it. The counter argument was, well, since 2/3 of the patients don't need it, then save it for later in Keynote 826 because there is an established overall survival advantage of 12.1 months.

I think the take-home message is that immune therapy checkpoint inhibitors, not just pembrolizumab but cemiplimab, are here and active and should be used both in the second-line and the frontline with chemotherapy and radiation. And when should they be used? That's the debate. It's a philosophical question.

My position is use the best medicines you have in the beginning, and you should counsel your patient that this is an FDA-approved opportunity. Now, also, NCCN-recommended [are those] in the highest risk group that are not eligible for surgery or treated with chemotherapy and radiation, they can get Pembrolizumab with the chemotherapy and radiation and in maintenance with an improvement in progression -free survival and overall survival based on a press release, but we haven't seen the data.

So this is brand new. Again, on the NCCN guidelines, it's been published in The Lancet by Keta Lorusso—Domenica, but her name is Keta. So I encourage you to read that paper, to listen to our debate, and most importantly, to consider the use of pembrolizumab with newly diagnosed, locally advanced high-risk cervical cancer. Thank you.

Source: 

Monk B. Immune checkpoint inhibitors + chemo/RT should be used as early as possible in cervical cancer. Presented at Great Debates and Updates in Women’s Oncology; May 3-4, 2024; New York, NY.