Potential biomarkers for predicting the efficacy of a pembrolizumab-containing regimen in advanced cervical cancer: A real-world analysis.

Objective: Prognostic biomarkers in patients with advanced cervical cancer treated with immune checkpoint inhibitors remain unclear. An evaluation of combined positive score (CPS) and tumor proportion score (TPS), and a comparison of their usefulness with inflammatory biomarkers in real-world data could be informative.

Materials and methods: We analyzed 28 patients who were treated with the KEYNOTE-826 regimen between November 2022 and June 2024. The complete cohort (group 1), patients with no prior chemotherapy (group 2), and treatment-naïve (group 3) were evaluated as follows: 1) CPS, TPS, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and hemoglobin, albumin, lymphocyte, and platelets (HALP score) in peripheral blood samples were obtained prior to initial treatment and KEYNOTE-826 regimen, and receiver operating curve analysis was used to compare them. The optimal cut-off values that showed the highest level of discrimination for progression-free survival were identified.

Results: The areas under the curve (AUC) for progression-free survival in group 2 were measured for CPS, TPS, NLR, PLR, and HALP scores before the KEYNOTE-826 regimen. The AUC values for these scores were 0.644, 0.662, 0.852, 0.667, and 0.700, respectively. The lower NLR (≤5.52) group had a significantly longer median survival than the higher NLR (>5.52) group (p˂0.001), with median survivals of 14.0 vs. 7.6 months, respectively. In group 3, CPS and TPS were highest at 0.700 for predicting progression-free survival, compared to NLR, PLR, and HALP score. CPS and TPS appear positively correlated with progression-free survival.

Conclusion: CPS and TPS showed a modest correlation with progression-free survival and NLR prior to immunotherapy demonstrated the best treatment efficacy for advanced cervical cancer.