Patterns of pembrolizumab use for recurrent cervical cancer.

Objective: This study aimed to examine the real-world use of pembrolizumab for recurrent cervical cancer as part of first-line or recurrence treatment, and its associated health care utilization.

Methods: The Merative MarketScan Research Databases were used to identify newly diagnosed patients with cervical cancer who underwent primary hysterectomy or radiation from 2017 to 2022. Systemic therapy utilization, including pembrolizumab, was assessed at first recurrence. Health care utilization (hospitalization, emergency department visits, and costs) during first-line treatments for recurrence was described for patients treated with and without pembrolizumab. Multivariable regression models explored factors associated with pembrolizumab adoption and differences in health care utilization.

Results: A total of 2727 patients were identified, including 1259 (46.2%) who underwent primary hysterectomy and 1468 (53.8%) who received primary radiotherapy. Chemotherapy for recurrence was initiated in 339 patients (12.4%). Recurrence treatment was noted in 9.7% of patients initially treated with hysterectomy and in 14.8% of those receiving primary radiotherapy. Among patients treated for recurrence, 24.8% received platinum alone, 52.5% a platinum-based combination therapy, and 22.7% non-platinum regimens. Forty-one patients (12.1%) received pembrolizumab. The median duration of first-line chemotherapy for recurrence was 2.3 months (interquartile range; 1.0-5.8) overall, and 4.3 months (interquartile range; 2.4-9.8) for patients treated with pembrolizumab. Pembrolizumab utilization was associated with more recent years of recurrence, advanced age, and prior chemotherapy. While pembrolizumab use was not associated with increased inpatient stays or emergency department visits, it was associated with significantly higher total costs and chemotherapy-related expenses.

Conclusions: Platinum-based chemotherapy is the predominant treatment for recurrent cervical cancer. Pembrolizumab utilization, although increasing, remains limited, highlighting a significant opportunity to optimize guideline-recommended therapies with proven efficacy in clinical trials.