Effects of Para-aortic Lymph Node Metastases on Endometrial Cancer Survival
March 31, 2020 01:11am
By Carrie L. Langstraat, MD
Shannon N. Westin, MD, MPH, FACOG, discusses the evolving role of immunotherapy as treatment of patients with endometrial cancer.
Shannon N. Westin, MD, MPH, FACOG, director of Early Drug Development and Phase I Trials in the Department of Gynecologic Oncology and Reproductive Medicine of the Division of Surgery at the University of Texas MD Anderson Cancer Center, discusses the evolving role of immunotherapy as treatment of patients with endometrial cancer. She says there is a lot of excitement surrounding this approach in these patients.
About 20% to 30% of patients with endometrial cancer will have microsatellite instability–high (MSI-H) disease, so they are eligible for checkpoint inhibitor monotherapy. At the Society of Gynecologic Oncology Annual Meeting, an update for the GARNET trial was presented, which demonstrated promising response rates a little over 40% in tumors that were MSI-H with dostarlimab, a PD-1 inhibitor, says Westin.
The other population of patients with endometrial cancer are those with microsatellite stable (MSS) disease, which makes up about 70% to 80% of uterine tumors, Westin says. Vicky Makker, MD, of Memorial Sloan Kettering Cancer Center, shared the data from the combination of lenvatinib (Lenvima) plus pembrolizumab (Keytruda), another checkpoint inhibitor. This approach seemed to achieve the sensitivity to checkpoint inhibition in these tumors without MSI.
The combination achieved durable and deep remissions, and in those patients, when they responded, their duration of response was not reached yet, Westin notes. The combination received approval from the FDA based on these findings in patients with MSS disease. The combination is also being evaluated in comparison with chemotherapy.