Endometrial cancer is a type of cancer that begins in the lining of the uterus, called the endometrium. It is the most common gynecologic cancer in the United States. Many cases are caught early, but deaths from rare and more aggressive types have increased each year. This rise has been especially high among Hispanic, Black and Asian women.
Treating women with advanced or recurring endometrial cancer has been hard for a long time. There haven’t been many options and most treatments didn’t work well once the cancer spread or came back.
Today, scientists are discovering new ways to treat the disease. One of the biggest advances is immunotherapy.
Robin Lacour, MD, a gynecologic oncologist with Banner MD Anderson Cancer Center, breaks down what immunotherapy is and how it is changing care.
What is immunotherapy?
“Immunotherapy is a cancer treatment that uses your own immune system to find and kill cancer cells,” Dr. Lacour said. “Instead of attacking cancer directly like chemotherapy and radiation do, immunotherapy helps your immune system recognize cancer as something foreign in your body and get rid of it more effectively.”
Your immune system is built to protect you. But cancer cells can hide or change so your body can’t find them easily. Immunotherapy works like a spotlight, identifying the cancer so your immune system can attack it.
This method has already changed how doctors treat melanoma, lung cancer, breast cancer and more.
A new wave of progress
In recent years, scientists have discovered that using immunotherapy with some targeted medicines can help shrink tumors, slow down cancer growth and help women live longer with a better quality of life.
One major advancement is a treatment that combines:
- A checkpoint inhibitor
- A targeted therapy
A checkpoint inhibitor removes the brakes on your immune system. Cancer cells often use these brakes to hide. When the brakes are gone, your immune system can find and attack cancer more easily.
Targeted therapy stops certain signals that help cancer cells grow and spread. When combined with a checkpoint inhibitor, they work even better together.
Why immunotherapy matters for advanced endometrial cancer
“For many years, women with advanced or recurrent endometrial cancer had very limited treatment options,” Dr. Lacour said.
Chemotherapy was usually the only treatment used. But it didn’t always work well when the cancer came back or spread. Immunotherapy has changed outcomes for the better.
Here’s why immunotherapy is generating so much hope:
- It can work even when chemotherapy doesn’t: Some women who didn’t respond to chemotherapy saw improvements after starting immunotherapy.
- It can help keep cancer away for a longer time: Instead of cancer coming back quickly, some women stay free of cancer or have longer periods without it.
- It often causes fewer side effects: Immunotherapy does have some risks, but many women say they feel better on immunotherapy than they did during chemo.
- It can be tailored to your tumor: Testing your tumor (known as biomarker testing) helps your care team choose the best immunotherapy approach for your cancer type.
- It’s opening doors to new combinations: Researchers are testing immunotherapy with radiation, surgery and other targeted treatments. Each trial helps us learn the best way to help future patients.
Immunotherapy options for endometrial cancer
Doctors may use different immunotherapy medicines to treat advanced or recurring diseases.
“For first-line therapy in advanced or recurrent endometrial cancers, immunotherapy in combination with chemotherapy is usually given regardless of biomarker testing,” Dr. Lacour said. “Biomarker testing is not required for first-line treatment with immunotherapy.”
In later lines of treatment, immunotherapy alone may be recommended instead of chemotherapy if a tumor has certain biomarkers. Biomarker testing can be especially helpful for people with tumors that do not respond to chemotherapy treatments.
Two common biomarkers tested for in endometrial cancer are MSI-H (microsatellite instability-high) and dMMR (deficient mismatch repair). If your tumor has these markers, immunotherapy may be especially effective.
Here are some of the main treatments used today:
Pembrolizumab or dostarlimab plus chemotherapy (PD-1 inhibitors)
These are the most common first-line treatments. They are usually used with regular chemotherapy medicines like carboplatin and paclitaxel.
This combination helps your immune system get stronger while chemotherapy targets cancer cells directly.
Pembrolizumab plus lenvatinib
If chemotherapy doesn’t work or the cancer returns, another choice is pembrolizumab with a targeted drug called lenvatinib.
This pair can help slow down or reduce tumor growth. It’s another big step for women who didn’t have many choices before.
Which immunotherapy is right for you?
The choice to give immunotherapy usually depends on how advanced your cancer is and what kind of cancer cells are in your tumor. Ask your health care team if immunotherapy and biomarker testing are right for you.
What immunotherapy treatment is like
Immunotherapy is usually given through an IV at an outpatient clinic. Most women go home the same day.
“Immunotherapy is typically given once every three weeks,” Dr. Lacour said. “Once you have had multiple doses (cycles), you may have longer time between treatments, depending on how well you handle it.”
Your care team will check on you at each visit to make sure your body is responding well. Some side effects might include diarrhea, rash, cough and thyroid problems. Usually, these side effects can be handled if they are noticed early.
Learn more about common side effects of cancer treatments.
Why early symptom awareness still matters
Even with new treatments available, recognizing early symptoms is important. Many women notice changes before a cancer diagnosis.
Talk to your health care provider if you have:
- Abnormal vaginal bleeding, especially after menopause
- Pelvic or abdominal pain
- Feeling full quickly
- Changes in bowel or bladder habits
- Ongoing tiredness
- Unexplained weight loss
“Vaginal bleeding after menopause, or abnormal vaginal bleeding before menopause, is the most common symptom of uterine or endometrial cancer,” Dr. Lacour said. “But it can also be a symptom of other medical conditions. Either way, visit your provider if you have any sort of abnormal bleeding.”
Takeaway
Immunotherapy is helping many women live longer, feel better and have more control over their treatment.
If you have advanced or recurring endometrial cancer, talk with your oncologist about whether immunotherapy or a combination of treatments might be right for you. There are more options now than ever before.
Find a Banner MD Anderson Cancer Center specialist near you.
