Immunotherapy for Advanced Endometrial Cancer
- For patients with advanced endometrial cancer, immunotherapy offers a new avenue of hope, especially after traditional treatments like surgery, chemotherapy, and radiation therapy have not been effective.
- Immunotherapy boosts the body’s immune system, enabling it to identify and target cancer cells more effectively than other treatments.
- In June 2024 the Food and Drug Administration (FDA) approved both durvalumab (brand name Imfinzi) with chemotherapy followed by maintenance durvalumab for certain patients and, most recently, pembrolizumab (brand name Keytruda) for all patients.
- Dostarlimib-gxly (brand name Jemperli) was previously approved for patients with a classification known as microsatellite instability (MSI)-high tumors in 2023.
In June 2024 the Food and Drug Administration (FDA) approved both durvalumab (brand name Imfinzi) with chemotherapy followed by maintenance durvalumab for certain patients and, most recently, pembrolizumab (brand name Keytruda) for all patients.
Read MoreIt is very exciting to now have three FDA-approved treatment options for a patient group that previously had few treatment options.
Understanding Immunotherapy
Immunotherapy works by empowering one’s own immune system to help fight cancer. It allows the normal cells of the immune system to identify and target cancer cells. This mechanism allows for the slowing down of cancer progression, which is essential in those with advanced endometrial cancer.
Unlike chemotherapy, which does not directly target cancer cells (often affecting healthy cells as well), immunotherapy works indirectly by enhancing the body’s natural defenses to try and precisely target cancer cells.
Immunotherapy is typically considered for advanced endometrial cancer (stage III-IV) when the disease has progressed despite standard treatments like surgery, chemotherapy, and radiation — or when the cancer is initially diagnosed at an advanced stage. It’s particularly valuable for patients whose cancer has not responded to previous treatments or for those with specific genetic markers that make immunotherapy more likely to be effective.
How is Immunotherapy Given?
In each of the three FDA-approved immunotherapy regimens, the immunotherapy drug is initially given in combination with standard chemotherapy. Then, after the chemotherapy treatments are completed, the immunotherapy is continued as a “maintenance” drug.
“Studies that were presented last year demonstrated that if you gave the patient with advanced or recurrent endometrial cancer standard chemotherapy — Taxol and carboplatin — for six treatments … combined with immunotherapy, followed by a maintenance period of immunotherapy, that patients had much better outcomes than if they were treated with chemotherapy alone,” Dr. Marta Crispens, oncologist and Director of Gynecology Oncology at Vanderbilt Health, told SurvivorNet.
Dr. Crispens elaborated that initially, it was found that when using immunotherapy to treat endometrial cancer, it was particularly “effective in patients whose cancers had MSI.” These findings made testing the cancer for MSI a critical aspect of treatment, as its presence would lead to better patient outcomes.
Encouragingly, the most recent approval of pembrolizumab is for all patients with advanced endometrial cancer, regardless of MSI status. This is because the publication of the landmark KEYNOTE-868/NRG-GY018 trial in the New England Journal of Medicine showed that pembrolizumab improved outcomes in both MSI-high and MSI-low patients.
This means that this new chemotherapy plus immunotherapy treatment combination would benefit more patients with advanced endometrial cancer. This is important because only approximately 15-30% of patients with advanced endometrial cancer have MSI-high tumors.
What Types of Immunotherapy are Used for Endometrial Cancer?
National Comprehensive Cancer Network (NCCN) guidelines for treating advanced endometrial cancer (stage III-IV disease) with immunotherapy include combining chemotherapy drugs carboplatin and paclitaxel (Taxol) with either pembrolizumab (Keytruda) or dostarlimab (Jemperli). These treatment recommendations are category 1 recommendations, the highest form of NCCN treatment recommendations that are given.
Recommendations for durvalumab in this context have not been added yet (as research is recent)
, but this may happen when the guidelines are updated.
What are the Benefits of Immunotherapy?
Previous studies and trials have demonstrated that for advanced endometrial cancer, immunotherapy, when combined with standard chemotherapy, improves the progression-free survival — or the time it takes for the disease to progress through treatment and likely, the overall survival of patients.
While the most significant advantages of immunotherapy are seen in patients with MSI, as previously noted, studies have shown immunotherapy can benefit other endometrial cancer patients as well.
What are the Side Effects?
Side effects from immunotherapy can occur almost anywhere in the body. Patients should be aware of potential side effects and report any changes to their doctors.
Some potential side effects include:
- Skin rashes
- Fatigue
- Loss of appetite
- Muscle and or joint pain
- Diarrhea
- Cough and shortness of breath
- Thyroid disease
- Type 1 diabetes
- Other autoimmune-like symptoms
Given the vast range of symptoms that may develop as a side effects of immunotherapy, it is important to see a doctor right away if they begin to develop during treatment to manage them and hopefully decrease their severity.
Learn more about SurvivorNet's rigorous medical review process.
