Targeted therapy for uterine cancer

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells and limit harm to normal cells. Targeted therapy may also be called molecular targeted therapy.

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

You may have targeted therapy to:

• treat some types of uterine cancer together with chemotherapy
• treat uterine cancer that doesn’t respond to other treatments or comes back (recurs) after treatment
• relieve pain or control symptoms of advanced-stage uterine cancer (called palliative therapy)

Different types of targeted therapy are used for uterine cancer.

Tumours need blood vessels to get nutrients and oxygen to survive and grow. The growth of new blood vessels is called angiogenesis. Angiogenesis inhibitors try to starve a tumour by stopping the development of new blood vessels. By inhibiting proteins that help signal new blood vessels to grow, angiogenesis inhibitors block cancer cells from getting what they need and cause cancer cells to die.

Lenvatinib (Lenvima) is an angiogenesis inhibitor that blocks the vascular endothelial growth factor receptor (VEGFR). It's also considered a type of tyrosine kinase inhibitor. You may be offered lenvatinib as palliative therapy for advanced-stage or metastatic endometrial carcinoma if all the following apply:

• the cancer is not the mismatch repair deficient (MMRd) or microsatellite instability-high (MSI-H) molecular subtype
• the cancer didn’t respond to treatment with a platinum-based chemotherapy drug (for example, carboplatin or cisplatin)
• the cancer can't be treated with surgery or radiation therapy

Lenvatinib is usually given together with the immunotherapy drug pembrolizumab (Keytruda).

Pazopanib (Votrient) is an angiogenesis inhibitor that blocks multiple kinase proteins including VEGFR, platelet-derived growth factor receptor (PDGFR) and fibroblast growth factor receptor (FGFR). You may be offered pazopanib for advanced-stage or recurrent uterine sarcoma if cancer didn’t respond to or continued to grow after treatment with chemotherapy.

Human epidermal growth factor receptor 2 (HER2) inhibitors are drugs that block the HER2 receptor. HER2 controls a protein on the surface of cells that helps them grow. Some cancer cells have more HER2 receptors than normal, which helps these cells to grow and multiply quickly. These cancers are called HER2 positive cancers.

Trastuzumab (Herceptin and biosimilars) is a type of HER2 inhibitor. You may be offered trastuzumab for HER2 positive, advanced-stage or recurrent endometrial carcinoma that is if all the following apply:

• the cancer is HER2 positive
• the cancer is either serous adenocarcinoma or carcinosarcoma (subtypes of endometrial carcinoma)

Trastuzumab is usually given together with the chemotherapy drug combination carboplatin and paclitaxel.

Neurotrophic tyrosine receptor kinase (NTRK) inhibitors are drugs that inhibit the NTRK protein.

The gene for NTRK tells nerve cells to make a protein that helps them send information about certain bodily sensations. When part of the NTRK gene breaks off and joins with another gene, it's called an NTRK gene fusion. This change causes abnormal proteins called TRK fusion proteins, which may cause cancer cells to grow.

Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) are types of NTRK inhibitors. You may be offered larotrectinib or entrectinib as palliative therapy for advanced-stage or metastatic uterine sarcoma if all of the following apply:

• the cancer has an NTRK fusion mutation
• the cancer didn’t respond to other treatment with other drug therapies
• the cancer can't be treated with surgery or radiation therapy

Larotrectinib and entrectinib are taken once daily as a pill by mouth (orally).

Side effects of targeted therapy will depend mainly on the type of drug or combination of drugs, the dose, how it's given and your overall health. Tell your healthcare team if you have side effects that you think are from targeted therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

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

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