Read about cancer treatment options listed by gene mutation, type of cancer and type of treatment.

Biomarkers, targeted and immunotherapies for endometrial cancer

This section covers the following topics:


Biomarker tests

Biomarker 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

Biomarker tests may be used to select treatments, and help patients avoid side effects from treatments that will not work for them. Biomarker 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 Biomarker Testing section for more information. 

  • Experts recommend testing all endometrial cancers for an abnormality known as MSI-H (microsatellite instability high") also known as "mismatch repair deficiency" (dMMR or MMR-D).
    • MSI-high cancers are common in people with a Lynch syndrome gene mutation. People with advanced or metastatic MSI-high endometrial cancer may respond well to a type of immunotherapy known as an immune checkpoint inhibitor
    • People with advanced, recurrent endometrial cancer that is not MSI-H, may benefit from a combination of the targeted therapy, Lenvima (lenvatinib) and the immunotherapy agent Keytruda.
  • Examples of additional biomarker 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 targeted therapy Vitrakvi (larotrectinib).
    • A biomarker 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 biomarker 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 FDA approved to treat tumors that have MSI-H or dMMR. It can also be used along with the targeted drug lenvatinib in women with advanced endometrial cancers that are not dMMR or MSI-H, usually after other treatments have been tried.


Targeted therapies

Targeted therapy 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 metastatic 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 immunotherapy 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 targeted therapy known as an mTOR inhibitor that has been used (off label) to treat some people with advanced endometrial cancer. Afinitor does not have FDA approval for use in endometrial cancer. 
  • Avastin (bevacizumab) helps block tumors from forming new blood vessels. Avastin does not have FDA approval for use in endometrial cancer. 


Table of targeted and immunotherapies for endometrial cancer

Name of drug Type of agent Cancer stage Indication Biomarker
Jemperli (dostarlimab) Immune checkpoint inhibitor Recurrent or advanced endometrial cancer For treatment of recurrent or advanced endometrial cancer that  is mismatch repair deficient (dMMR) that has progressed on or following a prior platinum-containing regimen. VENTANA MMR RxDx Panel
Keytruda (pembrolizumab)
 
Immune checkpoint inhibitor
 
Metastatic or  unresectable solid tumors  For treatment of solid tumors that have progressed after treatment and for which there are no other treatment options Microsatellite Instability High (MSI-H) or Mismatch Repair Deficiency (MMR-D
Metastatic or  unresectable solid tumors For the treatment of solid tumors that have progressed after treatment and for which there are no other treatment options Tumor Mutational Burden 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 MMR-D
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 MMR-D
Vitrakvi (larotrectinib) Kinase inhibitor Metastatic solid tumors For treatment in metastatic solid tumors where surgical resection is likely to result in severe morbidity, and  for which there are no satisfactory alternative treatments or the cancer progressed following treatment NTRK fusion
key-facts
  • All endometrial cancers should be tested for a biomarker known as MSI-H (also called MSI-high, dMMR or MMR-D)
  • Advanced cancers that are MSI-high may respond well to immunotherapy called immune checkpoint inhibitors. 
  • Cancers in people with Lynch syndrome are often MSI-high
paying-for-service

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 and laboratories have assistance programs that help cover the cost for their medications, tumor testing or genetic testing for an inherited mutation: 

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.
clinical-trials

The following studies may be of interest to women with endometrial cancer and an inherited mutation. 

Endometrial cancer specific

Advanced solid tumors of any type 

Visit our Research Search and Enroll Tool to find additional studies.