6ER-021 Prognostic factors of clinical outcome in real-world advanced cervical cancer patients receiving pembrolizumab treatment: a retrospective study

<h3>Background and Importance</h3> Cervical cancer ranks as the fourth most prevalent cancer among women globally, particularly in Asia. Since 2015, pembrolizumab has constantly demonstrated its effectiveness of significantly improving progression-free survival and overall survival through KEYNOTE 158, KEYNOTE 826, and KEYNOTE A18 trials. However, those trials included patients with various stages (based on the International Federation of Gynecology and Obstetrics (FIGO) 2014 staging system), resulting in high heterogeneity. Moreover, real-world data specified on prognostic factors in advanced cervical cancer patients after receiving pembrolizumab also remains limited and requires further investigation. <h3>Aim and Objectives</h3> This retrospective study aimed to analyse the prognostic factors in advanced cervical cancer patients receiving pembrolizumab treatment. <h3>Material and Methods</h3> This retrospective study extracted data from the electronic medical records database of the largest multi-institutional hospital system in Asia between January 2016 and December 2023. Patients diagnosed with advanced cervical cancer, defined as stage IV based on the FIGO 2014 staging system, and newly receiving pembrolizumab were included. We analysed clinical characteristics and prognostic factors including ages, pembrolizumab doses (fix 100 mg and fix 200 mg), previous systemic treatment, metastasis sites, de novo or recurrence metastasis, and PD-L1 positive score. The primary outcome was median overall survival (OS) by using Kaplan-Meier method. We employed univariable Cox regression to estimate the association of above prognostic factors and overall survival. <h3>Results</h3> We involved 63 pembrolizumab naive users, all Asian females, with a median age of 56.3 (IQR: 45.6 – 62.0) years and treatment duration of 6.0 (3.0 – 11.0) cycles. With an average follow-up time of 20.9 months, the median OS was 17.0 months (95% CI: 9.8 – 24.3). Analyses revealed that the metastasis site, specifically brain metastasis (HR: 7.9, 95% CI: 1.7 – 36.1) and liver metastasis (HR: 2.2, 95% CI: 1.1 – 4.5), significantly worsened OS. But, a fixed dose of 200 mg pembrolizumab (HR: 1.4, 95% CI: 0.7 – 2.6) had an insignificant worsening clinical outcome. <h3>Conclusion and Relevance</h3> This study indicates that brain and liver metastases significantly decreased overall survival. However, the impact of different dosages could not be determined by current outcomes. Further research is still required to investigate the prognostic factors in advanced cervical cancer patients receiving pembrolizumab treatment. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest