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Gynaecology: Cervix — immunotherapy with chemoradiotherapy (KEYNOTE-A18)

Free question published 21 October 2026

GynaecologyCervix — immunotherapy with chemoradiotherapy (KEYNOTE-A18)

A 47-year-old woman has newly diagnosed FIGO 2014 stage IIIB squamous cervical cancer with node-positive disease and good performance status. She is due to start definitive chemoradiotherapy. The MDT discusses whether to add an immune checkpoint inhibitor to the concurrent chemoradiotherapy and continue it afterwards. Which addition is supported by a significant improvement in progression-free survival?

  1. AAdding olaparib maintenance after chemoradiotherapy
  2. BAdding adjuvant carboplatin and paclitaxel after chemoradiotherapy
  3. CAdding pembrolizumab concurrently with chemoradiotherapy and as maintenance
  4. DAdding bevacizumab to chemoradiotherapy and maintenance
  5. EAdding nivolumab as maintenance monotherapy only, after chemoradiotherapy is completely finished

Why C is correct

KEYNOTE-A18 (ENGOT-cx11/GOG-3047) randomised high-risk locally advanced cervical cancer to pembrolizumab or placebo given concurrently with chemoradiotherapy and then as maintenance. Pembrolizumab reduced the risk of progression or death by 30% (HR 0.70, 95% CI 0.55-0.89) and improved overall survival, establishing pembrolizumab plus chemoradiotherapy as a new standard for FIGO stage III-IVA disease.

And why the others are not

  • AIncorrect. Olaparib has no role in definitive cervical chemoradiotherapy; it is a PARP inhibitor used in ovarian cancer maintenance.
  • BIncorrect. Adjuvant carboplatin-paclitaxel after definitive chemoradiotherapy (the OUTBACK strategy) did not improve survival.
  • DIncorrect. Bevacizumab is used in metastatic/recurrent cervical cancer, not added to definitive chemoradiotherapy in KEYNOTE-A18.
  • EIncorrect. The trial used pembrolizumab given both concurrently and as maintenance, not nivolumab maintenance alone.

Source KEYNOTE-A18 — pembrolizumab plus chemoradiotherapy for high-risk locally advanced cervical cancer — Lorusso D, Xiang Y, Hasegawa K, et al. Pembrolizumab or placebo with chemoradiotherapy followed by pembrolizumab or placebo for newly diagnosed, high-risk, locally advanced cervical cancer (ENGOT-cx11/GOG-3047/KEYNOTE-A18). Lancet, 2024.

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