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For the thousands of women in the U.S. who will be diagnosed with endometrial cancer this year, new guidelines from the National Comprehensive Cancer Network (NCCN) offer a glimpse at the most advanced treatments, including immunotherapy and molecular profiling.
Endometrial cancer, sometimes known as uterine cancer, is one of the few cancers that is causing an increasing number of deaths in the U.S. The National Cancer Institute estimates more than 66,000 new cases in 2023, with more than 13,000 deaths. It is the most diagnosed gynecologic cancer, and Black women are disproportionately affected—they are twice as likely as women of other groups to die from endometrial cancer.
Endometrial cancer begins in the lining of the uterus. The most common symptom is vaginal bleeding or discharge not related to the menstrual cycle. Other symptoms include:
- Pain in the pelvis
- Vaginal bleeding after menopause
- Abnormal findings on imaging such as pelvic ultrasound
Endometrial cancer is treatable with surgery when it’s found early, and the sooner it’s identified the better the chances of survival. Most people will be treated with surgical removal of the uterus, ovaries, and fallopian tubes. Radiation therapy and/or chemotherapy are often needed to help eliminate any remaining cancer cells in advance endometrial cancer or early stage yet aggressive tumor types.
Adding immunotherapy boosts progression-free survival.
For advanced endometrial cancers or those that come back after treatment, new guidelines from NCCN offer more guidance. New research found that combining standard chemotherapy with immunotherapy with can help patients with endometrial cancer live longer without their cancer getting worse.
The studies showed that patients who benefit most from these treatments have genetic changes in their tumors called mismatch repair deficiency (dMMR). About 20-30% of patients have dMMR tumors.
Two medications called immune checkpoint inhibitors were studied. In patients with dMMR tumors:
- Pembrolizumab combined with standard chemotherapy helped 74% of patients stay alive without their cancer getting worse for 12 months after treatment.
- Dostarlimab helped 61% of patients with dMMR tumors survived for 24 months without their cancer progressing.
In both studies, patients who received immunotherapy treatments did much better than patients who did not. This exciting research explains why the new NCCN guidelines recommend immunotherapy in addition to chemotherapy for patients with advanced or recurrent endometrial cancer, offering hope for an effective new treatment to help patients live longer.
MedStar Georgetown Cancer Institute at MedStar Washington Hospital Center offers immunotherapy and chemotherapy as initial treatment for advanced endometrial cancer, giving our patients the best chance at longer, healthier years of life.
Molecular profiling for personalized treatment.
Molecular profiling (biomarker testing) can tell us whether a tumor is likely to respond to a specific, targeted treatment like immunotherapy.
Biomarkers are abnormal proteins, cellular materials, or genes and chromosomes found in cancer cells and the surrounding tissues. Researchers have identified biomarkers of four types of endometrial cancer, and each can respond to treatment differently.
The doctor will use a sample of tissue obtained from biopsy or surgery to search for biomarkers that help them learn more about the tumor:
- Treatments that have an actionable biomarker
- Somatic or germline mutations as a cause of the cancer
- Determine if there are treatments that may be more effective with fewer side effects
The NCCN guidelines strongly encourage molecular profiling for initial evaluation of all patients diagnosed with endometrial cancer.
The most advanced cancer care for all patients.
Patients often come to us with advanced cancer that is challenging to treat. We offer state-of-the-art cancer care, with personalized treatments based on each patient’s condition.
We are participating in two clinical trials regarding endometrial cancer. The first is studying leading immunotherapy techniques in addition to personalized options to target unique tumor proteins. The second is tests the effectiveness of a new antibody drug conjugate that has shown success in treating breast cancer. Learn more about these studies and enrollment criteria.
Clinical studies offer a chance at gold-standard treatment along with the chance of getting an advanced therapy, all at no cost to the patient. The more women we can enroll in clinical studies, the better we can treat all types of early stage and advanced endometrial cancer.