SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Pharmacology of Anti-Cancer Drugs
Efficacy and Safety of Immune Checkpoint Inhibitors Combined with Chemoradiotherapy in Locally Advanced Cervical Cancer: A Systematic Review and Meta-Analysis
Chao Xiao 1,2
Siyuan Zeng 2
Luying Li 2
Ruiqi Wang 2
XUE XIAO 2
1. Zigong First People's Hospital, Zigong, China
2. Sichuan University West China Second University Hospital, Chengdu, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract
Background: Locally advanced cervical cancer (LACC) remains a leading cause of cancer-related morbidity and mortality, especially in low-and middle-income countries. While concurrent chemoradiotherapy (CCRT) is the standard of care for LACC, recurrence rates remain high, and the survival outcomes are suboptimal. Recent studies have suggested that immune checkpoint inhibitors (ICIs), such as pembrolizumab and durvalumab, could enhance the therapeutic efficacy of CCRT in LACC patients. Objective: This systematic review and meta-analysis aim to evaluate the efficacy and safety of ICIs in combination with CCRT for patients with LACC. Methods: A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and Cochrane Library from inception to November 2025. Randomized controlled trials (RCTs) and prospective cohort studies assessing the use of ICIs (pembrolizumab, durvalumab, atezolizumab) combined with CCRT for LACC were included. Outcomes analyzed included progression-free survival (PFS), overall survival (OS), objective response rate (ORR), complete response (CR), and treatment-related adverse events (AEs). Results: Data from five studies involving 1,987 patients were pooled. The addition of ICIs to CCRT significantly improved PFS (HR = 0.76, 95% CI: 0.64–0.91) and ORR (OR = 1.28, 95% CI: 1.06–1.56). Although the CR rate showed an improving trend, it did not reach statistical significance. Immune-related AEs (irAEs) were more common with ICI use (OR = 3.00, 95% CI: 1.68–5.34), but they were generally manageable. Severe irAEs leading to treatment discontinuation occurred in 5–7% of patients. Conclusions: This meta-analysis supports the combination of ICIs with CCRT as an effective treatment strategy for LACC, improving PFS and ORR without a significant increase in severe toxicity. However, further studies with mature OS data and exploration of optimal ICI timing are warranted.
Summary
Keywords
Chemoradiotherapy, immune checkpoint inhibitors, Immune-related adverse events, Locally advanced cervical cancer, Meta-analysis, Objective response rate, Progression-free survival
Received
12 December 2025
Accepted
26 January 2026
Copyright
© 2026 Xiao, Zeng, Li, Wang and XIAO. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Chao Xiao
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.