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Study: Immunotherapy improves outcomes of advanced endometrial cancer

Summary

Standard treatment for advanced endometrial cancer may soon change. A study found that people with advanced or recurrent endometrial cancer who received immunotherapy with chemotherapy had better outcomes than those who had chemotherapy alone. (Posted 12/4/23)

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Immunotherapy improves outcomes of advanced endometrial cancer

RELEVANCE

Most relevant for: People with advanced endometrial cancer. It may also be relevant for:

  • people with metastatic or advanced cancer
  • people with endometrial cancer

Relevance: High

Strength of Science: High

Research Timeline: Post Approval

Relevance Rating Details


What is this study about?

Researchers wanted to assess the usefulness of the drug Keytruda (pembrolizumab) when it is combined with chemotherapy for treating advanced or recurrent endometrial cancer. This study compared the outcomes of people who received a combination of Keytruda plus chemotherapy to people who only received chemotherapy.

Why is this study important?

The number of cases and deaths from endometrial cancer are increasing in the United States. This is especially true among Black women (see our XRAY review here). Currently, chemotherapy is the standard treatment for advanced or recurrent endometrial cancer. Unfortunately, long-term survival rates with this treatment remain low.

This study found that Keytruda plus chemotherapy increased the time before cancer came back compared to chemotherapy alone. The results of this and similar studies (see our XRAY review on a similar study here) will likely change the treatment for people who are newly diagnosed with advanced endometrial cancer.

Study findings

Just over 800 people with advanced or recurrent endometrial cancer were included in this study. Participants were placed in two groups:

  • Half of the participants received chemotherapy only.
  • Half of the participants received chemotherapy plus Keytruda.

After the 1-year time point in the study, among all participants:

  • Fewer people in the Keytruda-plus-chemotherapy group had cancer that worsened or came back than the group that received chemotherapy alone.
  • More people survived in the group that received Keytruda plus chemotherapy than in the group that received chemotherapy alone.

Mismatch repair

Doctors test pieces of tumors in labs to find  features (called biomarkers) that may help guide treatment.

Mismatch repair is a that measures how well cancer cells can repair certain types of damage.  

  • Some endometrial cancers are mismatch repair deficient (), which means that the cancer cells cannot repair certain types of changes. Cancers with are common among people with .
  • Some endometrial cancers are mismatch repair proficient (pMMR), which means that cancer cells can repair certain types of changes.

Keytruda plus chemotherapy worked particularly well for people with cancers.

  • After one year, people with dMMR-advanced or dMMR-recurrent endometrial cancer who had Keytruda plus chemotherapy were 70% less likely to have a recurrence or die.
  • After 8 months, people with pMMR-advanced or PMMR-recurrent endometrial cancer who had Keytruda plus chemotherapy were 46% less likely to have a recurrence or die.
Treatment Months until tumors came back
  tumors pMMR tumors
Keytruda + Chemotherapy It is too soon to know. Half of the participants in this group did not have their cancer come back after one year. 13.1 months
Chemotherapy 7.6 months 8.7 months

Side effects

Nearly everyone in the trial reported side effects of some kind. The most common side effects included:  

  • mild fatigue
  • numbness or pain in the hands or feet (neuropathy)
  • a lower-than-normal amount of red blood cells (anemia)
  • nausea
  • constipation
  • diarrhea

These side effects are similar to what would be expected for people receiving chemotherapy, even without the addition of .

Serious side effects occurred in a few participants, regardless of their treatment or whether they had tumors or pMMR tumors. These side effects included:

  • hypo or hyperthyroidism (too much or too little thyroid hormone)
  • heart attacks
  • infections in the blood
  • blockage of the intestines

and endometrial cancer

Keytruda is a type of drug known as an immune checkpoint inhibitor. This class of drugs works by helping the body’s immune system find and destroy cancer cells. Immune checkpoint inhibitors are effective for a wide range of cancers. This study adds additional support for the use of this type of together with chemotherapy as a treatment for advanced or recurrent endometrial cancer.

What does this mean for me?

If you have been diagnosed with advanced endometrial cancer, ask your healthcare providers about treatment with Keytruda plus chemotherapy instead of chemotherapy alone.

If you have already received treatment for advanced endometrial cancer and your cancer has come back, Keytruda might still be an option for you. In this study, people who already had radiation, hormone therapy or chemotherapy one year prior to the study benefitted from adding Keytruda to chemotherapy.

Recently, the Food and Drug Administration () approved the combination of a similar drug called Jemperli with chemotherapy for certain types of advanced endometrial cancer. You can read more about this approval in our XRAY review here.

Reference

Eskander RN, Sill MW, Beffa L, et al., Pembrolizumab plus chemotherapy in advanced endometrial cancer. New England Journal of Medicine; 2023; 388:2159-2170. Published online March 27, 2023.

Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

Share your thoughts on this XRAY review by taking our brief survey.  

posted 12/4/23

Questions To Ask Your Doctor
Questions To Ask Your Doctor

  • Is my endometrial cancer considered advanced?
  • Have you tested my cancer for biomarkers that may help guide treatment?
    • If so, what were my results?
    • If not, are there any tests that might be helpful for me?
  • Is Keytruda plus chemotherapy an option for me?

Guidelines
Guidelines

The National Comprehensive Cancer Network (NCCN) provides expert-developed guidelines for tumor testing of people with endometrial cancer. 

  • MMR and/or MSI tumor testing should be performed on all endometrial cancer tumors. 
  • Depending on MMR/MSI results, referral for genetic counseling to test for
  • Tumor testing for estrogen-receptor status (ER-positive or ER-negative) is recommended for 3, 4 () or recurrent endometrial cancer.
  • testing is recommended for advanced or recurrent cancers. 
  • Consider testing for NTRK gene fusion for or recurrent endometrial cancer. 
  • Consider (TMB) testing.

 

Updated: 08/05/2023

Open clinical trials
Open clinical trials

The following studies are enrolling people with advanced endometrial cancer.  

A number of other clinical trials for patients with endometrial cancer can be found here.

Updated: 12/05/2023

Peer Support
Peer Support

The following organizations offer peer support services for people with or at high risk for endometrial cancer:

Updated: 08/28/2022

Find Experts
Find Experts

The following resources can help you locate an expert near you.

Finding gynecologists with expertise in cancer risk and treatment

Related experts

Some symptoms and conditions related to female reproduction may be managed by other experts. 

Fertility experts

  • The Oncofertility Consortium maintains a national database of healthcare providers with expertise in fertility preservation and treatment of people who are diagnosed with cancer or have a high risk for cancer due to an .  
  • Livestrong has a listing of 450 sites that offer fertility preservation options for people diagnosed with cancer.
    Financial assistance may be available to make the cost of fertility preservation affordable for more patients. Patients are referred to those programs as needed.

Menopause experts

Sexual health experts

Other ways to find experts

  • The National Cancer Institute (NCI)-designated comprehensive cancer centers deliver cutting-edge cancer care to patients in communities across the United States. Most centers have specialized screening and prevention centers for high-risk people. Find a center near you and learn about its specific research capabilities, programs, and initiatives.
  • Register for the FORCE Message Boards to get referrals from other members. Once you register, you can post on the Find a Specialist board to connect with other people who share your situation.

Updated: 04/09/2023

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