Does Adding Atezolizumab to Frontline Therapy for Metastatic/Recurrent Cervical Cancer Improve Outcomes?

Immunotherapy (pembrolizumab) is FDA-approved for use with chemotherapy, with or without bevacizumab, in the frontline setting for patients with metastatic or recurrent cervical cancer with programmed cell death ligand 1 (PD-L1) tumor expression (combined positive score [CPS] ≥1). In the current study, investigators evaluated the PD-L1 inhibitor atezolizumab in combination with platinum-based chemotherapy and mandatory bevacizumab in patients with metastatic or recurrent cervical cancer, regardless of PD-L1 tumor expression. In the industry-funded, multinational, open-label, phase 3 trial, 410 patients were randomized to standard therapy (cisplatin or carboplatin, paclitaxel, and bevacizumab) either with or without the addition of atezolizumab.

The median follow-up was 32.9 months. The coprimary endpoints, median progression-free survival (PFS) and median overall survival (OS), were both significantly longer in the atezolizumab arm. Median PFS was 13.7 months with atezolizumab compared with 10.4 months with standard therapy alone (hazard ratio, 0.62; P<0.0001); median OS was 32.1 versus 22.8 months, respectively (HR, 0.68; P=0.0046). The safety profiles of the regimens were as expected and consistent with the profiles of the individual agents, with no new safety signals. Exploratory analysis for biomarkers, including PD-L1, was not reported.