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Women with advanced endometrial cancer may have better cancer free survival if they receive a combination treatment of immunotherapy and chemotherapy, according to a new study.

The study, published in The New England Journal of Medicine and presented at the Society of Gynecologic Oncology annual meeting, found that adding immunotherapy drug pembrolizumab, also known as Keytruda, to the standard chemotherapy regimen reduced the risk of disease recurrence by 70% in women with advanced or recurrent endometrial cancer.

Endometrial cancer is one of only a few cancers whose incidence and mortality rates are both rising. According to the National Cancer Institute, rates of new endometrial cancers have risen 0.6% per year from 2010 to 2019. Death rates have risen an average of 1.7% per year during the same time frame. By 2040, it is projected to be the third most prevalent cancer and fourth leading cause of cancer death among women.

This study is practice changing for the standard care of women with advanced or recurrent endometrial cancer.
Dr. Mian Shahzad, Gynecologic Oncology Program

“Historically, the overall survival rate for patients with recurrent or metastatic endometrial cancer has been poor, around two to three years,” said Dr. Mian Shahzad, a gynecologic oncologist at Moffitt Cancer Center. “This study is practice changing for the standard care of women with advanced or recurrent endometrial cancer.”

In the study, 816 patients were treated with either chemotherapy plus pembrolizumab or chemotherapy alone. Each patient received treatment every three weeks for six cycles, followed by up to 14 maintenance cycles every six weeks.

While patients with mismatch repair (MMR) deficient tumors had the best responses, those in the study with MMR-proficient disease who received the combination treatment still went on average 13.1 months before their disease progressed, compared to an average 8.7 months for patients who received chemotherapy only.

Immunotherapy is approved as a second-line treatment for endometrial cancer. Shahzad says this study demonstrates that immunotherapy should be offered as a front-line treatment for patients with advanced or recurrent disease, pending approval from the U.S. Food and Drug Administration.   

An estimated 66,200 cases of endometrial cancer will be diagnosed this year, according to the American Cancer Society. More than 13,000 women will die from the disease.

“This chemo-immunotherapy combination ignites a new hope,” Shahzad said.