Risk Management & Treatment

Biomarkers, targeted and immunotherapies for endometrial cancer

This section covers the following topics:


tests

tests look at samples of blood, tumor or other tissue for changes or abnormalities caused by cancer. These tests can give doctors clues about the cancer, including:

  • how fast the cancer is growing
  • which treatments are most likely to work
  • whether or not the cancer is responding to treatment or growing
  • whether or not the cancer has come back after remission


Biomarkers for treatment selection

tests may be used to select treatments, and help patients avoid side effects from treatments that will not work for them. tests used to select a specific treatment are sometimes called "companion diagnostic tests." These tests may be done on tumor tissue or (in many cases) on blood. See our Testing section for more information. 

  • Experts recommend testing all endometrial cancers for an abnormality known as MSI-H ( high") also known as "" ( or ).
    • cancers are common in people with a  gene mutation. People with advanced or MSI-high endometrial cancer may respond well to a type of known as an immune checkpoint inhibitor
    • People with advanced, recurrent endometrial cancer that is not MSI-H, may benefit from a combination of the , Lenvima (lenvatinib) and the agent Keytruda.
  • Examples of additional tests used in endometrial cancer include:
    • A rare type of endometrial cancer—known as a uterine sarcoma—may have a genetic change called an NTRK fusion, which can be found on tumor testing. Endometrial with an NTRK fusion may benefit from the Vitrakvi (larotrectinib).
    • A known as an NTRK fusion is rare in colorectal cancer
    • Estrogen receptor testing is used for advanced and recurrent endometrial cancers. 
    • Her2neu testing is used to find advanced or recurrent endometrial cancers that may respond to Herceptin.
    • Additional tumor testing may help identify people who are elegible for certain clinical trials. 


Immunotherapies 

Immunotherapies are cancer treatments that help the body’s immune system detect and attack cancer cells. There are several different categories of immunotherapies. 

  • Keytruda (pembrolizumab) is approved to treat tumors that have MSI-H or . It can also be used along with the targeted drug lenvatinib in women with advanced endometrial cancers that are not or MSI-H, usually after other treatments have been tried.


Targeted therapies

is still fairly new in the treatment of endometrial cancer. Currently, these agents are only prescribed if the cancer has recurred or as part of a clinical trial. Targeted therapies for endometrial cancer include:

  • Vitrakvi (larotrectinib) is approved for treatment of endometrial cancer that is or cannot be removed with surgery and has worsened with other treatments. It targets a specific genetic change called an NTRK fusion. This type of genetic change is found in a range of cancers, including a rare type of uterine cancer known as uterine sarcoma.
  • Lenvima (lenvatinib) helps block tumors from forming new blood vessels. Lenvima can be used along with the drug Keytruda to treat some advanced endometrial cancers, typically after at least one other drug treatment has been tried.
  • Afinitor (everolimus) is a type of known as an mTOR inhibitor that has been used (off label) to treat some people with advanced endometrial cancer. Afinitor does not have approval for use in endometrial cancer. 
  • Avastin (bevacizumab) helps block tumors from forming new blood vessels. Avastin does not have approval for use in endometrial cancer. 


Table of targeted and immunotherapies for endometrial cancer

Name of drug Type of agent Cancer Indication
Jemperli (dostarlimab) Immune checkpoint inhibitor Recurrent or advanced endometrial cancer For treatment of recurrent or advanced endometrial cancer that  is mismatch repair deficient () that has progressed on or following a prior platinum-containing regimen. VENTANA MMR RxDx Panel
Keytruda (pembrolizumab)
 
Immune checkpoint inhibitor
 
or  unresectable   For treatment of that have progressed after treatment and for which there are no other treatment options High (MSI-H) or  (
or  unresectable For the treatment of that have progressed after treatment and for which there are no other treatment options High (TMB-H)
Advanced endometrial cancer Combined with Lenvima (lenvatinib) for patients whose cancer has progressed after treatment and who are not candidates for surgery or radiation  Tumor is not MSI-H or
Lenvima
(lenvatinib)
Tyrosine kinase inhibitor Advanced endometrial cancer

Combined with pembrolizumab, for the treatment of women whose cancer has progressed after treatment and who are not candidates for surgery or radiation 

Tumor is not MSI-H or
Vitrakvi (larotrectinib) Kinase inhibitor solid tumors For treatment in solid tumors where surgical resection is likely to result in severe , and  for which there are no satisfactory alternative treatments or the cancer progressed following treatment NTRK fusion

key-facts key-facts

  • All endometrial cancers should be tested for a known as MSI-H (also called , or )
  • Advanced cancers that are may respond well to called immune checkpoint inhibitors. 
  • Cancers in people with are often

find-support find-support

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

updated: 11/27/2021

paying-for-service paying-for-service

Paying for cancer treatment

The majority of public and private health insurance plans are required to cover cancer diagnosis and treatment; copays, coinsurance and deductibles often apply. Patient costs and coverage for specific doctors, facilities or treatments may vary based on your health plan. Visit our section on Insurance and Paying for Care: Treatment  for more information, links to sample appeal letters and other resources. 

Some pharmaceutical companies have assistance programs that help cover the cost for their medications: 

Organizations that offer co-pay assistance:

Other resources:

  • The American Cancer Society provides information and resources on covering the cost of cancer care. Public assistance, such as Medicaid may be available if you are ineligible for other programs. 
  • Needy Meds: Assistance programs to help patients with cost of medications and other healthcare.
  • Triage Cancer offers tools and resources to help individuals cope with the financial aspects of a cancer diagnosis.

updated: 01/22/2022

paying-for-service paying-for-service

Paying for testing

Insurance companies are required to cover the costs for cancer treatment. However, health plans may vary on the amount of out-of-pocket costs and coverage for specific doctors, facilities or treatments. Your doctor's office and treating hospital should disclose how much your treatment may cost you and work with your insurance company to help you plan for the cost of your care. Visit our Health Insurance Appeals page for additional information on insurance appeals. 

Medicare will cover the cost for genetic testing and testing for people who meet certain criteria. Medicare coverage varies based on the policies of Medicare in your region. Visit this site to find and contact your regional Medicare provider for more information about coverage. The Medicaid website has a link to state Medicaid programs, which list specific eligibility for each state.

Some laboratories have assistance programs that help cover the cost for tumor testing: 

Organizations that offer co-pay assistance:

Other resources:

  • The American Cancer Society provides information and resources on covering the cost of cancer care. Public assistance, such as Medicaid may be available if you are ineligible for other programs. 
  • Triage Cancer offers tools and resources to help individuals cope with the financial aspects of a cancer diagnosis.

updated: 01/22/2022

clinical-trials clinical-trials

The following are studies enrolling people with advanced endometrial cancer.  

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

updated: 01/18/2022

Last updated January 23, 2022