Page 181 - EJMO-9-2

Eurasian Journal of
Medicine and Oncology PD-1/L1 inhibitors in advanced CC: Multicenter retro

the patients, 52.2% tested positive in the treatment group particularly in cases of advanced or recurrent disease. 11,15
compared with 20.0% in the control group (Table 3). The KEYNOTE-A18 trial marked a pivotal milestone
Survival analysis showed that there was no significant by demonstrating that combining pembrolizumab with
difference in either PFS (median PFS: 17.0 vs. 15.0 months, chemoradiotherapy significantly improved PFS in locally
p=0.227, Figure 3A) or OS (p=0.797, Figure 3B) between advanced cervical cancer, with a 36-month PFS rate of 69.3%
the treatment and control groups. compared to 53.6% in the placebo group. This outcome
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represents a critical advancement, solidifying the clinical
4. Discussion utility of immunotherapy in the treatment of cervical
The significant influence of immunotherapy, specifically cancer. Conversely, the global multicenter phase III CALLA
PD-1/PD-L1 inhibitors, on the treatment of cervical cancer trial, which employed a similar study design, indicated
has been progressively substantiated by clinical trials and that the combination of durvalumab and radiotherapy
real-world evidence. Recent developments highlight the did not significantly improve PFS in patients with locally
capacity of these agents to reshape therapeutic approaches, advanced cervical cancer (hazard ratio = 0.84, p=0.174)
without biomarker screening despite an acceptable safety
Table 2. Univariate Cox regression analyses on the profile. Unlike KEYNOTE-A18, the CALLA trial did not
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associations of different clinical factors with patients’ mandate PD-L1 testing, which may explain the differences
progression‑free survival rates in results. These findings collectively suggest that PD-L1

Characteristics Hazard 95% p‑value expression, as measured by the CPS, serves as a predictive
ratio confidence biomarker for immunotherapy efficacy, underscoring the
interval need for standardized biomarker screening protocols in
Histology 0.89 0.45 – 1.75 0.73 clinical practice. These findings suggest that the biomarker
Age 0.95 0.68 – 1.32 0.74 screening strategy may modulate the clinical efficacy of
Surgery 1.37 0.97 – 1.93 0.08 immunotherapy. Within this study, our research team
conducted a large-scale, real-world investigation (n=192)
PD-L1 expression 1.00 0.77 – 1.31 1.00 involving a Chinese cohort diagnosed with advanced
FIGO stage 1.27 0.87 – 1.86 0.21 cervical cancer, with the primary objective of assessing
The first-line treatments 0.43 0.30 – 0.61 0.00* the clinical utility of PD-1/PD-L1 inhibitors as first-
containing PD-1/PD-L1 inhibitors line systemic therapy. The findings demonstrated that
Tumor diameter 0.90 0.75 – 1.10 0.29 combination immunotherapy recapitulated the PFS benefit
Note: *Indicates statistical significance at p<0.05. observed in the KEYNOTE-A18 trial within a real-world
Abbreviations: FIGO: Federation of Gynecology and Obstetrics; clinical setting (hazard ratio = 0.43, p=0.00), although no
PD-1: Programmed cell death protein 1; PD-L1: Programmed statistically significant improvement in OS was yet evident,
death-ligand 1.
Table 3. Baseline characteristics of patients with stage IVB cervical cancer

Characteristics Total (n=48) (%) Treatment group (n=23) (%) Control group (n=25) (%) t‑test or Chi‑square test p‑value
Age (years)
Median (range), years 53 (33 – 75) 53 (35 – 75) 54 (33 – 73)
Mean±standard deviation 51.9±11.0 53.4±9.9 54.6±9.1 t=0.411 0.683
χ =0.042 0.838
2
>50 32 (66.7) 15 (65.2) 17 (68.0)
≤50 16 (33.3) 8 (34.8) 8 (32.0)
Histological features 0.350
Squamous cell carcinoma 43 (89.6) 22 (95.7) 21 (84.0)
Adenocarcinoma 5 (10.4) 1 (4.3) 4 (16.0)
PD-L1 expression 0.059
CPS ≥1 17 (35.4) 12 (52.2) 5 (20.0)
CPS <1 4 (8.3) 1 (4.3) 3 (12.0)
Unknown 27 (56.3) 10 (43.5) 17 (68.0)
Note: Data are presented as n (%) unless otherwise specified.
Abbreviations: CPS: Combined positive score; PD-L1: Programmed death-ligand 1.

Volume 9 Issue 2 (2025) 173 doi:10.36922/ejmo.8074