Updated May 2026

​The KEYNOTE-826 trial showed that in patients with persistent, recurrent, or metastatic cervical cancer, the addition of pembrolizumab to platinum-based chemotherapy with or without bevacizumab significantly improved progression-free and overall survival for patients with PD-L1 positive tumours (CPS ≥1)¹⁸.  Therefore, for patients with tumour with CPS ≥1, and no contraindications to Bevacizumab standard of care is carboplatin-paclitaxel-bevacizumab and pembrolizumab (BC Cancer protocol UGOCXCATBP).  Quadruplet therapy is given for 6 cycles, and patients with no sign of progressive disease can continue onto maintenance bevacizumab and pembrolizumab under protocol GOCXBP. Pembrolizumab can be switched to a 6 weekly dosing schedule in the maintenance setting.

BC Cancer protocol permits a maximum of 36 cycles or 18 cycles of 3 weekly and 6 weekly pembrolizumab respectively. Retreatment may be permitted (see protocol for eligibility).

For patients that are ineligible for Pembrolizumab or tumour CPS <1, standard of care treatment is carboplatin-paclitaxel +/-bevacizumab (BC Cancer protocol GOCXCATB) until disease progression or unacceptable toxicity. After 6 cycles with CAP approval patients can transition to maintenance bevacizumab alone. The addition of Bevacizumab has been shown to improve overall survival compared to chemotherapy alone¹⁹. For patients who have oligoprogression on or after completing 1^st line systemic therapy, consideration should be given to local therapy to progressive sites (i.e. SBRT, IR guided procedures) to allow continuation of maintenance therapy.  Local therapy is generally not recommended for patients with multifocal progression on bevacizumab +/- pembrolizumab maintenance and second line therapy should be considered.

In Canada, limited treatment options exist beyond first line therapy. New therapies are needed for recurrent cervical cancer and patients with progressive disease should be prioritized for clinical trial enrollment. Biomarker testing can be considered to identify potential druggable targets through clinical trials or patient support programs. (i.e. HER2+ disease treated with anti-HER2+ targeting agent).  Outside of clinical trials, for patients with a relatively long chemotherapy free interval (i.e. >6 months from last dose of carboplatin-paclitaxel) re-treatment with carboplatin and/or paclitaxel can be considered. Beyond this, single agent chemotherapy (i.e. gemcitabine, topotecan) can be offered but there is limited data and there is no evidence that use of these agents improves overall survival. Patients with treatment-resistant disease should be offered palliative care support alongside oncology care to optimize symptom control, psychosocial support, and quality of life.

http://www.bccancer.bc.ca/health-professionals/clinical-resources/chemotherapy-protocols/gynecology