Treatment patterns and PD-L1 testing among persistent, recurrent, or metastatic cervical cancer patients in the United States community oncology setting.

Abstract

5522 Background: Pembrolizumab was approved for persistent, recurrent, or metastatic cervical cancer (PRM-CC) among patients (pts) with PD-L1 expression in October 2021. This followed its June 2018 approval for PD-L1-positive recurrent, metastatic pts who progressed after chemotherapy. This real-world study aimed to describe treatment patterns and PD-L1 testing patterns among pts with PRM-CC between 2018-2024. Methods: Electronic medical record data from The US Oncology Network identified adult PRM-CC pts diagnosed between July 2018 and July 2022 and followed through June 2024. Persistent disease was defined as either absence of a complete response or provider-documented progression within 90 days following the completion of initial CC-related treatment. Results: There were 216 PRM-CC pts eligible for the study. Overall, median age was 55 years and median duration of follow-up was 12.8 months. Overall, 56% (n = 121) of PRM-CC pts had documented PD-L1 testing during the study observation period, of which 78% (n = 94) had a positive result and 7% (n = 8) had undocumented result. Among PD-L1 positive pts without metastatic disease at initial diagnosis (n = 121), 41% were tested after PRM-CC diagnosis date and had a median time from diagnosis to PD-L1 testing of 1.4 months, and 11% were tested prior to PRM-CC diagnosis date. PD-L1 testing increased from 54% to 69% after October 2021, yet 43% of PD-L1+ patients did not receive pembrolizumab after 2021. 12% (8/69) of pts who received pembrolizumab did not have documented PD-L1 testing. Pembrolizumab was received by 27 pts in 1L (pre-2021: 16, post-2021: 11) and 26 patients in 2L pre-2021: 17, post-2021: 9). Most patients had metastatic disease (74%, n = 159), of which 60% (n = 95) presented with metastatic disease at initial diagnosis. Concurrent chemoradiation prior to metastatic disease was received by 38% (n = 81) of pts. The majority of pts with metastatic disease received first line (1L) treatment (n = 86%, n = 137) and 28% (N = 45) of pts initiated 2L treatment. During the first regimen of 1L, 96 pts received a platinum+taxane-containing regimen (+bevacizumab, n = 72). Conclusions: Between 2018-2024, many PRM-CC pts were not tested for PD-L1 although biomarker-driven treatments were available. Among those tested, almost half of PD-L1 positive patients did not receive standard-of-care therapy. The current treatment landscape provides a valuable opportunity to standardize and enhance PD-L1 testing in order to optimize treatment selection and support personalized care in this population. Overall Pembrolizumab initiation-Yes Pembrolizumab initiation-No PD-L1 Testing 216 69 147 Tested, N(%) 121 (56.0) 61 (88.4) 60 (40.8) Positive 94 (77.7) 52 (85.2) 42 (70.0) Negative 19 (15.7) 4 (6.6) 15 (25.0) No result 8 (6.6) 5 (8.2) 3 (5.0) Not Tested, N (%) 95 (44.0) 8 (11.6) 87 (59.2)