Who should be treated with pembrolizumab in addition to standard of care in advanced cervical cancer?

Keynote-826 study demonstrated that the addition of pembrolizumab to standard systemic therapy contributes to progression-free and overall survival in patients with persistent, recurrent, or metastatic cervical cancer receiving chemotherapy with or without bevacizumab. However, we do have some comments about the study. The lack of additional survival benefit of pembrolizumab in patients with de novo metastatic disease or in elderly patients or in patients with combined positive score (CPS) < 1 may be due to the absence of abscopal immune effects of radiotherapy or primary resistance (immunodeficiency or immune escape or immunosenescence) to adaptive immunotherapy. We believe that new studies are needed to add pembrolizumab particularly in the treatment of the patients with de novo metastatic disease, PD-L1 CPS of < 1%, and advanced cervical cancer in geriatric population.