Chemo plus immunotherapy improves survival in advanced endometrial cancer

Adding immunotherapy to the first-line treatment for advanced and metastatic endometrial cancer may significantly improve some oncologic outcomes, particularly within the mismatch repair deficiency/microsatellite instability-hypermutated (MMRd/MSI-H) subset, suggests a study.

“This specific subgroup is currently a focal point of investigation for evaluating the potential of chemotherapy-free regimens,” the investigators said.

This systematic review and meta-analysis was performed on phase III trials that examined the role of immunotherapy in the first-line setting for advanced or recurrent endometrial cancer. A total of 2,320 patients were included in the pooled analysis.

The addition of immunotherapy to first-line chemotherapy provided a significant improvement in progression-free survival when compared to chemotherapy alone (hazard ratio [HR], 0.70, 95 percent confidence interval [CI], 0.62‒0.79) across all patient groups.

Of note, patients with MMRd/MSI-H tumours benefitted the most from the combined treatment. This PFS benefit, although less robust, was consistent among those with MMR-proficient/microsatellite stable tumours (n=1,757; HR, 0.74, 95 percent CI, 0.60‒0.91).

Furthermore, chemotherapy plus immunotherapy also led to improved overall survival (OS) relative to chemotherapy alone in all patients (HR, 0.75, 95 percent CI, 0.63‒0.89), but the OS data maturity remained low.

Current exploratory studies are trying to identify nonresponding patients who are eligible for inclusion in clinical trials, according to the investigators.

“A growing body of evidence supports the integration of immunotherapy with chemotherapy as a first-line treatment strategy,” they said. “Recently, findings from ongoing trials such as RUBY (NCT03981796), NRG-GY018 (NCT03914612), AtTEnd (NCT03603184), and DUO-E (NCT04269200) have been disclosed.”