Efficacy and safety of anti-PD-1/PD-L1 immunotherapy in advanced endometrial cancer: a systematic review

Abstract

Introduction: Endometrial cancer is the most common malignant neoplasm of the female genital tract in developed countries. The standard first-line treatment in advanced stages is platinum-based chemotherapy. However, a standardized chemotherapy regimen is not available for second and subsequent lines after disease progression. Immune checkpoint inhibitors, which target PD-1 proteins (pembrolizumab, nivolumab, dostarlimab, and sintilimab) or PD-L1 (durvalumab and avelumab), have emerged as effective alternatives in the second-line treatment of advanced or recurrent endometrial cancer, either as monotherapy or in combination with other targeted therapies. Materials and Methods: We conducted a bibliographic search of articles published in the last 5 years. Databases such as PubMed, Web of Science and Cochrane have been used for this purpose. Results: Twelve articles were selected for review that collect efficacy and safety data on the use of immunotherapy in patients with advanced endometrial cancer who have previously received at least one line of platinum-based chemotherapy treatment. Four of the publications refer to the use of pembrolizumab, in monotherapy or associated with lenvatinib, two of them being carried out by the same research team. Conclusions: Immunotherapy presents a high response rate in advanced endometrial cancer that expresses alteration of the DNA base repair pathway and microsatellite instability. In comparison to conventional chemotherapy in patients with advanced endometrial cancer, immunotherapy has shown efficacy, either as monotherapy or in combination with other targeted therapies.