Extrapolating from KEYNOTE-A18, would you consider adding pembrolizumab to chemoradiation for locally advanced vulvar cancer?   

This is a very interesting and important question. Although we have no prospective data on vulvar cancer regarding this question, our treatments have invariably paralleled the cervix. PD-L1 expression is estimated to be ~50%. Similarly, in KEYNOTE-158, RR in PD-L1 + cervix cohort was 15%, while...

I would not add IO as part of chemo RT for cancer of the vulva. It’s not the same as cervical cancer with around 30-70% HPV positive depending on demographics. We need prospective data in this setting before a change in practice.