Immunotherapy in Locally Advanced Cervical Carcinoma: A Narrative Review

The treatment of locally advanced cervical cancer is based on concomitant cisplatin-based chemoradiotherapy followed by brachytherapy. The quality of this treatment is essential to optimize results. In particular, intensity-modulated radiotherapy followed by image-guided brachytherapy achieves 90% local control regardless of the stage of the disease. More recently, several randomized trials have changed the management of these tumors: The INTERLACE trial evaluated the benefits of neoadjuvant chemotherapy with carboplatin and paclitaxel and demonstrated a survival benefit for this approach. This trial has been the subject of considerable criticism. The KEYNOTE A.18 trial evaluated the addition of pembrolizumab to standard treatment: an improvement in overall survival was demonstrated for patients with stage III-IV disease (FIGO 2014 classification). The CALLA trial, which evaluated the addition of durvalumab, was negative. This review summarizes the biological rationale for this immunotherapy, its results, and the quality criteria for chemoradiotherapy. It describes the various trials in detail, puts their results into context, and discusses the relevance of this new treatment based on the patients' baseline characteristics. Based on this critical analysis, patients with stage III-IVA cervical cancer (FIGO 2014 classification) should receive, in addition to standard chemoradiotherapy, concomitant treatment with pembrolizumab followed by two years of maintenance therapy.