Cervical Cancer — SCE Medical Oncology MCQ

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HardGynaecological CancersCervical CancerSCE Medical Oncology

A previously untreated, fit 46-year-old has FIGO 2014 stage IIIB squamous cervical cancer, with a 5.5 cm primary extending to the pelvic wall and no distant metastases. As of June 2026, which package reflects the positive NICE final draft and current UK licence for definitive treatment?

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Correct answer: D — Combine pembrolizumab with cisplatin chemoradiotherapy and image-guided brachytherapy, then continue pembrolizumab alone

The June 2026 positive NICE final draft covers untreated FIGO 2014 stage III to IVA cervical cancer; pelvic-wall extension explicitly establishes FIGO 2014 stage IIIB eligibility in this patient. The current UK SmPC specifies pembrolizumab concurrently with definitive chemoradiotherapy, including external-beam radiotherapy followed by brachytherapy, and then pembrolizumab monotherapy for up to 24 months if there is no progression or unacceptable toxicity. Give pembrolizumab during cisplatin chemoradiotherapy but stop it before image-guided brachytherapy: this incorrectly truncates pembrolizumab before completion of the definitive radiation package and omits continuation monotherapy. Give cisplatin chemoradiotherapy and image-guided brachytherapy without adding pembrolizumab: this is the former standard comparator but omits the newly supported pembrolizumab component for the specified stage and date. Combine pembrolizumab with cisplatin chemoradiotherapy, then replace brachytherapy with an external-beam boost: brachytherapy remains an essential component of definitive treatment. Give neoadjuvant pembrolizumab-platinum, then radical hysterectomy with pelvic nodal dissection: this is not the licensed or NICE-evaluated package for untreated stage III disease.

Reference: NICE GID-TA11215 final draft: pembrolizumab with chemoradiotherapy for untreated locally advanced cervical cancer (Positive final draft guidance, issued June 2026): https://www.nice.org.uk/guidance/gid-ta11215/documents/674; KEYTRUDA 25 mg/mL UK summary of product characteristics (Current UK SmPC, updated June 2026): https://www.medicines.org.uk/emc/product/2498/smpc; Royal College of Radiologists radiotherapy for cervix cancer (Current UK clinical oncology guidance, accessed July 2026): https://www.rcr.ac.uk/our-services/all-our-publications/clinical-oncology-publications/radiotherapy-for-cervix-cancer/