Evolving Role of Immunotherapy in Endometrial Cancer

Ruchi Garg, MD, chair of gynecologic oncology at City of Hope Atlanta, Chicago, and Phoenix, discusses the option of immunotherapy for the treatment of endometrial cancer and highlights 2 studies that have recently influenced the space.

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0:10 | Immunotherapy definitely has impacted endometrial cancer management. In fact, at the Society of Gynecologic Oncology meeting that was in March of this year, we had treatment changing altering trials that were presented including NRG GYO18 [NCT03914612] and RUBY trials [NCT03981796]. They both established the role of immunotherapy even in upfront settings for endometrial cancer. Essentially, the NRG GYO18 trial, looked at [patients with] advanced endometrial cancer, stage III and IV, and looked at the use of pembrolizumab [Keytruda], which is 1 of the commonly used immunotherapies, along with chemotherapy, and compared that with chemotherapy and subsequently, immunotherapy maintenance was also part of the protocol. There was a significant progression-free survival and a difference that was noted.

1:11 | One of the factors that we look at is something called MMR, the mismatch repair deficiency, in endometrial cancers. In that cohort of patients, the progression-free survival was 74% vs 38% with almost a 70% difference in relative risk essentially. However, even in the cohort that was proficient for this, for MMR, there was a progression-free survival, a difference that was noted for 13 months vs 8 months. Therefore, the new standard of care, and even NCCN guidelines, says that we should be utilizing carboplatin and paclitaxel along with pembrolizumab [Keytruda] for advanced endometrial cancers in upfront or recurrent settings when they are chemotherapy-naïve.

2:07 | Similarly, the RUBY trial showed the benefit of dostarlimab along with the chemotherapy. It's a PD-1 inhibitor, and it looked at the PD-1 inhibitor combination with chemotherapy vs chemotherapy and again, found a profound effect on the [progression-free survival] where it was almost double at 36% vs 18%. It was even more pronounced in the mismatch repair deficient patients where it was about 61% vs 15% or so.