Patient-reported outcomes from the phase 3, randomized, double-blind, placebo-controlled ENGOT-cx11/GOG-3047/KEYNOTE-A18 study of pembrolizumab plus concurrent chemoradiotherapy in participants with high-risk locally advanced cervical cancer

Randall L.; Xiang Y.; Matsumoto T.; Giannarelli D.; Milla D.P.; Lopez K.A.; Acevedo A.; Vizkeleti J.; Salani R.; Nogueira-Rodrigues A.; Mejia F.C.; Korach J.; Akilli H.; Lee J.-Y.; Saevets V.V.; Samouelian V.; Sehouli J.; Tharavichikul E.; Sukhin V.; Colombo N.; Chang C.-L.; Cueva J.F.; Lalondrelle S.; Petru E.; Szamreta E.; Nguyen A.M.; Yamada K.; Li K.; Pignata S.; Lorusso D. · Gynecologic Oncology (2025) · DOI: 10.1016/j.ygyno.2025.06.003

Resumen

Objective: In ENGOT-cx11/GOG-3047/KEYNOTE-A18 (NCT04221945), pembrolizumab (vs placebo) + concurrent chemoradiotherapy (CCRT) followed by pembrolizumab (vs placebo) significantly improved progression-free survival and overall survival in participants with newly diagnosed, high-risk locally advanced cervical cancer (LACC). We report patient-reported outcomes (PROs) from the study. Methods: Participants (≥18 years) with high-risk LACC (FIGO 2014 stage IB2–IIB with node-positive disease or stage III–IVA) were randomized 1:1 to 5 cycles of pembrolizumab 200 mg or placebo Q3W plus CCRT, followed by 15 cycles of pembrolizumab 400 mg or placebo Q6W. CCRT was 5 cycles (optional 6th dose) of cisplatin 40 mg/m2 Q1W plus external beam radiotherapy followed by brachytherapy. Secondary PRO endpoints included EORTC QLQ-C30 GHS/QoL and physical functioning subscales and EORTC QLQ-CX24 symptom experience scale; EQ-5D-5L visual analogue scale (VAS) was an exploratory endpoint. No alpha was assigned to the PRO analyses. Results: 1008 (95.1 %) of 1060 randomized participants were included in the PRO full analysis set population. No meaningful between-group differences were observed for any of the prespecified PRO instruments. Between-group differences (95 % CIs) in least-squares mean score changes from baseline to week 36 (primary time point) were 0.57 (−2.34 to 3.49) for QLQ-C30 GHS/QoL, 0.64 (−1.54 to 2.82) for QLQ-C30 physical functioning, 0.54 (−1.02 to 2.09) for QLQ-CX24 symptom experience, and −0.55 (−2.97 to 1.86) for EQ-5D-5L VAS. Empirical mean score changes over time and the proportions of participants whose scores improved, remained stable, or deteriorated over time were similar between treatment arms. Conclusions: Pembrolizumab+CCRT did not negatively impact participants' health-related quality of life.