The Gynecologic Oncology Institute investigative reporters uncovered this review of a relatively new way to treat advanced endometrial cancer. The good news for endometrial cancer patients is that the vast majority are cured with surgery alone, due to early stages at diagnosis. But when the cancer is advanced or recurrent it is a challenge to treat with standard chemo and radiation. Enter the new wave of molecular and immunomodulatory therapies. This new frontier is giving much more hope for advanced endometrial cancer patients.
“Immunotherapy, which boosts the patient’s immune system response against cancer, is an emerging area of treatment and research. The immunotherapeutic pembrolizumab (Keytruda) is approved for the treatment of women whose endometrial cancer cells have certain properties.
What type of endometrial cancer does immunotherapy work for?
Pembrolizumab is effective in shrinking or slowing the growth of a minority of Endometrial cancer. These are advanced cancers whose cells are known as microsatellite unstable (MSI) or MMR deficiency (mismatch repair). Both MSI- and MMR-deficient tumors have a large number of DNA mutations that make them “hot” – that is, they can provoke a response from immune T cells.
Most endometrial cancers do not have MSI or MMR properties and are therefore considered “cold” and are not good candidates for immunotherapy with pembrolizumab.
Advanced or recurrent endometrial cancer classified as MSS (microsatellite stable) can be treated with pembrolizumab plus the drug lenvatinib, which targets multiple growth factor receptors that play a role in cancer-promoting pathways.
How does pembrolizumab work?
Pembrolizumab targets PD-1, a protein on T cells of the immune system that prevents T cells from attacking other cells, including cancer cells. By blocking PD-1, pembrolizumab releases immune T cells to recognize and attack cancer cells. Drugs like pembrolizumab are known as checkpoint inhibitors because they target the checkpoints that inhibit the immune response.”