Efficacy of programmed cell death protein 1/programmed death ligand 1 inhibitors as first-line treatment for advanced cervical cancer: A multicenter retrospective study

Abstract

The KEYNOTE-A18 trial recently demonstrated the benefits of first-line treatment with programmed cell death protein 1/programmed death ligand 1 (PD-1/PD-L1) inhibitors for advanced cervical cancer. Herein, we investigated this using real-world data from a large Chinese cohort. From January 2020 to June 2023, 91 patients diagnosed with advanced cervical cancer receiving first-line systemic therapy incorporating PD-1/PD-L1 inhibitors were recruited as the treatment group, while 101 patients who did not receive PD-1/PD-L1 inhibitors were included as the control group. Baseline characteristics, including patient age, the International Federation of Gynecology and Obstetrics (FIGO) stage, histological subtypes, tumor diameter, PD-L1 expression, overall survival (OS), and progression-free survival (PFS), were extracted from the medical records. Survival analysis was performed utilizing the Kaplan-Meier curve and Cox regression analysis was used to compare the effects of different factors on patients’ survival. The addition of PD-1/PD-L1 inhibitors significantly prolonged PFS compared to the control group (median PFS: 19 vs. 11 months, p=0.000). Stratified analysis showed that higher expression of PD-L1 (median PFS: 14 vs. 14 months, p=0.031), earlier FIGO stage (median PFS: 20 vs. 11 months, p=0.000), and tumor diameter ≤4 cm (median PFS: 47 vs. 12 months, p=0.000) were associated with a better PFS. No statistical difference was detected in OS between the two groups. In the stage IVB subgroup, PD-1/PD-L1 inhibitors showed no benefits in either OS or PFS. Moreover, Cox regression analysis showed that only the use of PD-1/PD-L1 inhibitors was associated with prolonged PFS (hazard ratio = 0.43, 95% confidence interval 0.30 - 0.61, p=0.000). The first-line treatment containing PD-1/PD-L1 inhibitors significantly delayed tumor recurrence, especially for those with positive expression of PD-L1 and relatively small tumors.

Keywords

Programmed cell death protein 1/programmed death ligand 1 inhibitors / Advanced cervical cancer / First-line treatment / the International Federation of Gynecology and Obstetrics stage / Programmed death ligand 1 status / Tumor diameter

Funding

None.

Conflict of interest

The authors declare they have no competing interests.

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