The immunotherapy drug pembrolizumab (Keytruda) is now available for people in England and Scotland with some forms of advanced cervical cancer.
Early trial results suggest that, on average, pembrolizumab can stop some incurable cervical cancers from growing for 8 months longer than current treatments.
It may also help some people with cervical cancer live longer overall. It’s the first immunotherapy approved for treating cervical cancer in the UK.
That’s thanks to two separate decisions. First, in February, the Scottish Medicines Consortium (SMC) recommended pembrolizumab as a routine treatment for women with incurable cervical cancer on NHS Scotland. Then, in March, the National Institute for Health and Care Excellence (NICE) approved its use through the Cancer Drugs Fund for the same group in England.
“It’s good news that people with advanced cervical cancer in England and Scotland can access pembrolizumab while more data is collected about how well it works through the ongoing clinical trial,” says Kruti Shrotri, our head of policy development.
Pembrolizumab and cervical cancer
Around 3,200 women are diagnosed with cervical cancer in the UK each year. The incidence is highest between the ages of 30 and 34.
Cervical cancer starts when abnormal cells in the lining of the cervix (the lower part of the womb) grow in an uncontrolled way, forming a tumour.
Pembrolizumab has been recommended for advanced forms of cervical cancer that either don’t respond to other treatments, have come back after other treatments, or have spread to other parts of the body. It’s given alongside the the current standard care for these groups, which includes chemotherapy with or without the targeted cancer drug bevacizumab (Avastin).
How does pembrolizumab work?
Pembrolizumab is a type of immunotherapy called a checkpoint inhibitor. It works by guiding immune cells to target a specific feature of cancer cells. It’s used to treat people whose tumours include a lot of that feature, a protein called PD-L1.
oth the SMC and NICE decisions were made using evidence from the KEYNOTE-826 trial, which showed that adding pembrolizumab to the current standard of care increases the time before advanced cervical cancers that express a lot of PD-L1 spread or get bigger.
That evidence suggests that pembrolizumab may help some people with advanced cervical cancer live longer. But, as the trial isn’t finished yet, it’s not clear just how big that benefit might be.
Because these long-term benefits are still unclear, pembrolizumab is only approved for up to two years of uninterrupted treatment. This is also why NICE only chose to recommend it for use through the Cancer Drugs Fund, rather than as a routine part of NHS treatment in England.
The next steps
The Cancer Drugs Fund pays to give patients promising cancer treatments while NICE continues to assess how well they work.
“Pembrolizumab shows promise as the first effective immunotherapy,” explained Helen Knight, director of medicines evaluation at NICE. “However, to ensure the best use of limited public funding, we need additional evidence to fully analyse its clinical and cost effectiveness before it can be considered for routine NHS use.
“Recommending pembrolizumab to the CDF means people have faster access to care while this further evidence is gathered.”
NICE estimates that 400 people in England with advanced cervical cancer will be eligible to receive pembrolizumab through the CDF.
NICE decisions are usually followed in Wales and Northern Ireland.