Efficacy and safety of PD-1/PD-L1 inhibitors plus chemotherapy ± bevacizumab for recurrent or metastatic cervical cancer: a systematic review and meta-analysis of randomized controlled trials
In brief
Adding checkpoint inhibitors extends median survival by 9 months in advanced cervical cancer
Across six randomized trials involving 2,242 patients with recurrent or metastatic cervical cancer, adding PD-1 or PD-L1 inhibitors to chemotherapy, with or without bevacizumab, was associated with median survival of 28.7 months versus 19.4 months and progression-free survival of 12.0 versus 8.7 months. Any-grade side effects were similar, but severe side effects increased modestly; longer-term safety and which patients benefit most remain important questions.
- Journal
- Frontiers in immunology (Q1)
- Published
- 19 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Raoshan Luo, Minghong Li, Li Ma, Zhilong Huang
- PMID
- 42973905
- DOI
- 10.3389/fimmu.2026.1972995
Why clinicians should know about it
- Picked for Oncology and Radiation Oncology (paper of the day, 4 November 2026): SR/MA of RCTs, PD‑1/PD‑L1 + chemo ± bevacizumab improves OS
Abstract
BACKGROUND: The efficacy of adding PD-1/PD-L1 inhibitors to chemotherapy ± bevacizumab in recurrent or metastatic cervical cancer is under active investigation. OBJECTIVE: To systematically evaluate the efficacy and safety of PD-1/PD-L1 inhibitors combined with chemotherapy ± bevacizumab in this setting through a meta-analysis of randomized controlled trials (RCTs). METHODS: A systematic search of PubMed, Embase, Web of Science, Cochrane Library, Scopus, and ClinicalTrials.gov was conducted for RCTs published up to January 14, 2026. Primary outcomes were overall survival (OS) and progression-free survival (PFS); hazard ratios (HRs) were derived from reconstructed Kaplan-Meier curves. RESULTS: Six RCTs involving 2,242 patients were included: 1,131 received PD-1/PD-L1 inhibitors plus chemotherapy ± bevacizumab, and 1,111 received chemotherapy ± bevacizumab alone. The combination regimen significantly prolonged median OS (28.7 vs. 19.4 months) and median PFS (12.0 vs. 8.7 months). Pooled risk ratios (RRs) for complete response, partial response, stable disease, progressive disease, and objective response rate were 1.606 (95% CI, 1.333-1.936), 1.127 (95% CI, 0.994-1.277), 0.733 (95% CI, 0.612-0.878), 0.460 (95% CI, 0.305-0.695), and 1.235 (95% CI, 1.153-1.322), respectively. The risk of any-grade adverse events did not differ significantly between groups (RR 0.999, 95% CI 0.991-1.008), whereas the combination was associated with an increased risk of grade ≥3 adverse events (RR 1.069, 95% CI 1.019-1.121). Frequently reported adverse reactions included nausea, anemia, constipation, arthralgia, neutropenia, hypertension, alopecia, and peripheral neuropathy. CONCLUSION: In patients with recurrent or metastatic cervical cancer, the addition of PD-1/PD-L1 inhibitors to chemotherapy ± bevacizumab significantly improves OS and PFS, though with a modest increase in high-grade toxicity. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/, identifier CRD420261472748.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.