Immunotherapy for uterine cancer

Immunotherapy helps strengthen or restore the immune system's ability to fight cancer. This works to kill cancer cells and stop cancer cells from growing and spreading.

Some people with uterine cancer have immunotherapy. If you have immunotherapy, your healthcare team will use what they know about the cancer and about your health to plan the drugs, doses and schedules.

Immunotherapy may be the only treatment you have or it may be used along with other treatments. You may have immunotherapy to:

• destroy cancer cells left behind after surgery and reduce the risk that uterine cancer will come back (recur) (called adjuvant therapy)
• treat advanced-stage (stage 3 or stage 4) uterine cancer or cancer that comes back (recurs) after treatment
• relieve pain or control the symptoms of advanced or metastatic uterine cancer (called palliative therapy)

The immune system usually stops itself from attacking normal cells in the body by using specific proteins called checkpoints, which are made by some immune system cells. Uterine cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. Immune checkpoint inhibitors are drugs that work by blocking the checkpoint proteins so immune system cells, such as T cells, can recognize, attack and kill the cancer cells.

These drugs are monoclonal antibodies, which means that they find and attach to a specific antigen on a cancer cell.

Pembrolizumab (Keytruda) is an immune checkpoint inhibitor that targets the PD-1 checkpoint protein. You may be offered pembrolizumab for advanced or recurrent endometrial carcinoma if the cancer didn’t respond or recurred after treatment with platinum-based chemotherapy drug (for example, carboplatin or cisplatin).

If the cancer is the mismatch repair deficient (MMRd) molecular subtype, pembrolizumab may be given by itself if the cancer is recurrent. If the cancer is not the MMRd molecular subtype, you may be offered pembrolizumab together with the targeted therapy drug lenvatinib (Lenvima).

Pembrolizumab is given by a needle into a vein (intravenously) once every 3 to 6 weeks. There is no standard for how long pembrolizumab is given, but doctors may have you take it for up to 2 years.

Dostarlimab-gxly (Jemperli) is another immune checkpoint inhibitor that targets PD-1. It may be offered for advanced or recurrent endometrial carcinoma that is the MMRd molecular subtype with the chemotherapy drug combination carboplatin and paclitaxel.

If cancer didn’t respond to or progressed after treatment with a platinum-based chemotherapy drug (for example, carboplatin or cisplatin), dostarlimab-gxly may be offered on its own.

Dostarlimab-gxly is given intravenously once every 3 to 6 weeks. There is no standard for how long dostarlimab-gxly is given, but doctors may have you take it for up to 3 years.

Durvalumab (Imfinzi) is another immune checkpoint inhibitor that targets PD-1. It may be offered for advanced or recurrent endometrial carcinoma that is the MMRd molecular subtype with the chemotherapy drug combination carboplatin and paclitaxel, followed by maintenance therapy with durvalumab alone.

Side effects of immunotherapy will depend mainly on the drug or drug combination, the dose, and your overall health. Tell your healthcare team if you have side effects that you think might be from immunotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Common side effects of treatment with immune checkpoint inhibitors for uterine cancer include:

• nausea and vomiting
• diarrhea
• constipation
• fatigue
• flu-like symptoms, such as fever, chills and muscle or joint aches
• skin problems, including rash, itchiness, and sores around the mouth and vagina
• headache and dizziness
• loss of appetite
• low blood cell counts
• eye and vision problems
• shortness of breath
• a cough that won’t go away
• thyroid problems

Dostarlimab-gxly may also cause more serious side effects including liver problems, kidney problems, heart problems (such as an irregular heartbeat) and seizures.

Find out more about immunotherapy. To make the decisions that are right for you, ask your healthcare team questions about immunotherapy.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.