For metastatic small cell cervix cancer, would you consider adding immunotherapy up front (per a small cell lung cancer paradigm)?  

In December 2018, Horn et al reported the results of a phase 3 clinical trial in the NEJM (N Engl J Med 2018; 379:2220-2229). This trial included previously not treated patients with metastatic small cell lung cancer (PD-L1 expression not required). The patients all received carboplatin and etoposide. Double blind randomization was then used for atezolizumab vs placebo given concurrently with chemotherapy. Overall survival was improved with atezolizumab.  

We often talk about treating small cell cervix cancer according to the small cell lung paradigm. Following this line of thinking, do you feel it is appropriate to try to add immune therapy to this group of patients. We are unlikely to ever accrue enough small cell cervix patients to answer this question in a clinical trial. Do you feel it might be appropriate to extrapolate from lung data?