Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Immunotherapy for locally advanced cervical cancer: a systematic review to inform Australia’s first Cervical Cancer Management Guidelines. (146443)

Susan Yuill 1 , Denise Cambell 1 , Telma Costa 1 , Dana Stefanovic 1 , Catherine Shannon 2 , Kathryn Middleton 3 , Jim Nicklin 4 5 , Yee Leung 6 7
  1. University of Sydney, Sydney, NSW, Australia
  2. Mater Cancer Care Centre, Brisbane, Queensland, Australia
  3. Mater Hospital, Brisbane, Queensland, Australia
  4. Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
  5. University of Queensland, Brisbane, Queensland, Australia
  6. King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
  7. University of Western Australia, Perth, Western Australia, Australia

Aim:

Despite Australia’s progress towards cervical cancer elimination, some people will still present with locally advanced disease (LACC). Concurrent chemoradiation with brachytherapy (CCRT+BT) remains the standard of care, yet 30–35% experience disease progression. Immunotherapy has demonstrated benefit in metastatic disease and is currently being evaluated for LACC. We conducted a systematic review (SR) and GRADE Evidence-to-Decision assessment to inform the first Australian Cervical Cancer Management Guidelines.

 Methods:

A SR was conducted following PRISMA 2020 guidelines comparing immunotherapy plus CCRT (I+CCRT) with CCRT alone in people with LACC (FIGO 2018 stage IB3/IIA2-IVA). Eligible studies included randomised controlled trials or SRs thereof. Outcomes included overall survival (OS), progression-free survival (PFS), grade 3-4 adverse events (AEs) and quality of life (QoL). Searches using MEDLINE, EMBASE, and Cochrane databases identified one relevant SR (Zhao 2024), which we updated. In consultation with the multi-disciplinary Guidelines Working Party (WP), 3+-year (preferably 5+-year) OS and QoL were identified as critical outcomes to inform the recommendation process.

Results:

Two trials met inclusion criteria: CALLA (durvalumab) and ENGOT-cx11/GOG-3047/KEYNOTE-A18 (pembrolizumab); (both included immunotherapy maintenance therapy to two years). Only KEYNOTE-A18 reported both critical outcomes. Three-year OS was significantly higher in the pembrolizumab (82.6%) versus the control arm (74.8%) (hazard ratio 0.67, 95%CI:0.50–0.90; p=0.00). QoL at 36 weeks did not differ significantly between the two arms.

Conclusion:

The WP conditionally recommended adding pembrolizumab to CCRT+BT for patients with FIGO 2018 III/IVA disease regardless of PD-L1 status, emphasising shared decision-making, including discussion of immunotherapy-related AEs and patient preferences. Subsequent announcement of Government subsidisation of pembrolizumab for LACC should ensure equitable access. Recommendation and subsidisation decisions were based on improvement in 3-year OS. Key uncertainties remain, including the magnitude of long-term survival benefit pending 5-year OS data, use of biomarkers to optimise patient selection, and whether the two-year-maintenance-immunotherapy duration can be safely shortened.