Abstract Body (Do not enter title and authors here): Introduction:
Pembrolizumab is a potential treatment for both locally advanced and metastatic cervical cancer with high PD-L1 expression. However, emerging evidence indicates that pembrolizumab use is associated with several adverse cardiac events, including myocarditis, pericarditis, heart failure, and arrhythmias. Despite these concerns, cardiovascular outcomes in cervical cancer patients receiving pembrolizumab remain underexplored.

Research Questions:
What are the cardiovascular outcomes in cervical cancer patients treated with pembrolizumab and chemotherapy compared to those treated with chemotherapy alone?

Methods:
We conducted a retrospective cohort study using data from the U.S. Collaborative Network TriNetX, covering the period from January 2019 to January 2025. Cervical cancer patients were identified using ICD-10 codes and categorized into two cohorts: those who received pembrolizumab in combination with chemotherapy and those treated with chemotherapy alone. To enhance comparability between groups, baseline characteristics—including demographics, comorbidities, cancer stage, type of chemotherapy, and medication use—were balanced using propensity score matching.

Results:
After propensity score matching, 2,180 patients were included in each group, with no significant differences in baseline characteristics or medication use. Over a three-year follow-up period, patients receiving pembrolizumab had a higher risk of major adverse cardiovascular events (HR 1.544 95% CI 1.323-802, P < 0.0001), myocarditis or pericarditis (HR 1.875 95% CI 1.654-2.126, P < 0.0001), acute myocardial infarction (HR 1.423 95% CI 1.035-1.958, P = 0.0293), heart failure exacerbation (HR 1.647 95% CI 1.382-1.961, P < 0.0001), stroke (HR 1.37 95% CI 1.017-1.846, P = 0.0378) and new-onset atrial arrhythmia (HR 1.455 95% CI 1.038-2.038, P = 0.0286).

Conclusion:
Our study found that Pembrolizumab use in cervical cancer patients is associated with an increased risk of cardiovascular events. Further research is needed to develop effective strategies for monitoring and preventing these cardiovascular complications.