When Can Immunotherapy Be Used to Treat 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 drugs used to treat advanced endometrial cancer may include pembrolizumab (Keytruda) and dostarlimab (Jemperli), administered via IV infusions, oral pills, or injections, often in combination with chemotherapy.
- Immunotherapy boosts the body’s immune system, enabling it to identify and target cancer cells more effectively than other treatments.
- Immunotherapy may be more effective in patients with a genetic condition known as Microsatellite Instability (MSI), which makes tumors more visible to the immune system. Testing for MSI is crucial in determining the effectiveness of immunotherapy for advanced endometrial cancer patients.
- However, studies indicate that the immunotherapy-chemotherapy combination treatment led to better outcomes in patients without MSI as well.
In particular, a combination of drugs with immunotherapy has demonstrated improved survival outcomes for patients with advanced endometrial cancer. This is very important for a patient group that had previously not had many great options.
Read MoreWhen is Immunotherapy Given?
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 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.Immunotherapy is initially given in combination with chemotherapy.
“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, tells SurvivorNet.
Dr. Crispens notes that this improvement with the immunotherapy combination treatment was seen in all patients — regardless of the presence of a genetic marker known as microsatellite instability or MSI.
What is MSI & How Does it Impact Treatment With Immunotherapy?
MSI is a genetic marker characterized by changes in the length of microsatellites (short, repeated sequences of DNA) due to errors in the DNA mismatch repair system. Essentially, tumors with high levels of MSI accumulate numerous mutations, making them more recognizable to the immune system. Therefore, immunotherapy has been found to be especially effective against tumors with a high amount of MSI.
Dr. Crispens tells SurvivorNet 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, newer studies have even shown that patients without the presence of MSI benefit from treatment combinations that include immunotherapy as well. This means that this new chemotherapy plus immunotherapy treatment combination would benefit more patients with advanced endometrial cancer.
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.
Both pembrolizumab and dostarlimab are monoclonal antibodies that bind to what is called the PD-1 receptor on normal immune T-cells, helping the T-cells block interaction with a receptor on the cancer that allows it to avoid the T-cells.
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.
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