​​Updated May 2026

Primary Concurrent Chemoradiation

Results from five randomized phase 3 trials show an average overall survival advantage for cisplatin-based therapy given concurrently with radiation therapy¹⁵. Although the trials vary somewhat in terms of stage of disease, dose of radiation, and schedule of cisplatin and radiation, they all demonstrate significant survival benefit for this combined approach. The protocol designation for this therapy is GOCXCRT. It consists of weekly cisplatin at 40 mg/m2 weekly for five weeks during external beam radiation therapy.

Additional Treatment Options

KEYNOTE-A18 (ENGOT-cx11), a phase 3 randomised placebo controlled clinical trial, demonstrated that the addition of pembrolizumab 200 mg IV q3 weekly X 5 cycles to chemoradiotherapy and then as 15 cycles of 400 mg q6 weekly maintenance therapy in patients with newly diagnosed high-risk, locally advanced cervical cancer improved (regardless of PDL-1 CPS score status) both overall and progression-free survival¹⁶.

INTERLACE phase 3 randomised clinical trial demonstrated that six weeks of induction chemotherapy with weekly dose dense carboplatin and paclitaxel before standard chemoradiotherapy improved 5-year survival outcomes for patients with locally advanced cervical cancer.

Either strategy may be considered for appropriate patients in addition to standard of care CRT.  Decisions around treatment recommendations should involve multi-disciplinary discussion¹⁷. There is overlap of patient stage inclusion criteria between the two studies and based on expert consensus provincially, the following treatment algorithm has been proposed. This acknowledges that the standard of care remains chemoradiation and additional systemic therapy can be considered for selected patients based on provider-patient discussion. 

​Recommendations for Additional Treatment Option Application

* the choice of therapy should be reviewed by a multidisciplinary team involving RO and MO and incorporate patient factors and preference as well as the ability to adhere to treatment timing

**CRT = chemoradiation with concurrent cisplatin

*** concurrent CRT should start no later than the 7^th week of induction chemotherapy start

^a Avoid induction chemo followed by para-aortic irradiation (i.e. > 1 pathologic lymph node at the common iliac or above or ≥3 pathologic lymph nodes) due to bone marrow toxicity

^b CDA review and recommendation: patients previously staged to have IB-IIB disease who also had with lymph node involvement (FIGO 2014) are now considered to have stage IIIC disease (FIGO 2018) and should be considered eligible for maintenance pembrolizumab.

https://www.cda-amc.ca/sites/default/files/DRR/2025/PC0411-Keytruda_FINAL_Recommendation.pdf