# KEYNOTE-A18: pembrolizumab with chemoradiotherapy for locally advanced cervical cancer (overall survival)

Source: https://onco.cc/key-papers/paper-keynote-a18-os-lancet-2024/  
OnCo record `paper-keynote-a18-os-lancet-2024` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The second report from KEYNOTE-A18 showed that adding pembrolizumab to chemoradiotherapy for high-risk locally advanced cervical cancer also lengthened life: 82.6% of women were alive at three years against 74.8%, a third fewer deaths.

## Summary

Second interim analysis of the double-blind, placebo-controlled phase 3 ENGOT-cx11/GOG-3047/KEYNOTE-A18 trial, in which 1,060 patients with newly diagnosed, high-risk locally advanced cervical cancer (FIGO 2014 stage IB2-IIB node-positive or stage III-IVA) were randomised to pembrolizumab or placebo with cisplatin-based chemoradiotherapy followed by pembrolizumab or placebo maintenance.

At data cutoff on 8 January 2024 (median follow-up 29.9 months) median overall survival was not reached in either group; 36-month overall survival was 82.6% with pembrolizumab against 74.8% with placebo, hazard ratio for death 0.67 (p=0.0040), meeting the primary objective. Grade 3 or higher adverse events occurred in 78% and 70% of patients, and potentially immune-mediated adverse events in 39% and 17%. Together with the progression-free survival report it established immuno-chemoradiotherapy as a new standard of care for this population.

## Fields

- Kind: Key paper
- Last checked: 2026-09-08
- Journal: The Lancet
- Year: 2024
- DOI: 10.1016/S0140-6736(24)01808-7
- Authors: Lorusso D, Xiang Y, Hasegawa K, et al.
- Findings: 36-month overall survival 82.6% (95% CI 78.4-86.1) vs 74.8% (70.1-78.8); HR for death 0.67 (95% CI 0.50-0.90, p=0.0040).; Median follow-up 29.9 months; median overall survival not reached in either group.; Grade 3 or higher adverse events 78% vs 70%, most often anaemia and falls in white cell and neutrophil counts.; Potentially immune-mediated adverse events 39% vs 17%.
- What it means: The survival gain turns the earlier progression-free survival result into a clear reason to offer pembrolizumab with and after chemoradiotherapy to women with node-positive or stage III-IVA cervical cancer. Because cervical cancer is concentrated in low- and middle-income countries, the benefit reaches most women only if pricing and access follow.
- Caveats: Interim analysis with median follow-up under three years; late recurrences are possible in this disease.; High-risk population only; the negative CALLA trial suggests lower-risk patients may not benefit.; About two years of pembrolizumab is costly where cervical cancer burden is highest.

## Sources

- Lancet 2024 (OS): https://doi.org/10.1016/S0140-6736(24)01808-7
- PubMed: https://pubmed.ncbi.nlm.nih.gov/39288779/
- ClinicalTrials.gov NCT04221945: https://clinicaltrials.gov/study/NCT04221945

## Connected records

- cancers: [Cervical cancer](https://onco.cc/cancers/cervical/), [Locally advanced cervical cancer](https://onco.cc/cancers/locally-advanced-cervical-cancer/)
- technologies: [Brachytherapy](https://onco.cc/technologies/brachytherapy/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Platinum agents](https://onco.cc/technologies/platinum/)
- targets: [PD-1](https://onco.cc/targets/pd1/)
- drugs: [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- companies: [Merck & Co. (MSD)](https://onco.cc/companies/merck/)
- institutions: [Policlinico Universitario A. Gemelli](https://onco.cc/institutions/gemelli/)
- terms: [Combined positive score (CPS)](https://onco.cc/terms/cps/), [Overall survival (OS)](https://onco.cc/terms/os/), [Progression-free survival (PFS)](https://onco.cc/terms/pfs/), [Standard of care](https://onco.cc/terms/standard-of-care/)
- trials: [KEYNOTE-A18 / ENGOT-cx11 / GOG-3047](https://onco.cc/trials/keynote-a18/)
- people: [Domenica Lorusso](https://onco.cc/people/domenica-lorusso/), [Giovanni Scambia](https://onco.cc/people/giovanni-scambia/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [No one can predict who responds to immunotherapy](https://onco.cc/bottlenecks/b-immunotherapy-response/), [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)

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