By Erika Edwards -
NBC News
Women with advanced endometrial cancer may live longer before their tumors return if they receive immunotherapy and chemotherapy at the same time, according to two studies published Monday in the New England Journal of Medicine.
These findings, which will also be presented Monday at the Society of Gynecologic Oncology annual meeting in Tampa, Florida, are expected to transform the way cancer physicians treat women in advanced stages of their disease.
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“This is going to dramatically change the conversation” with patients, “probably starting tomorrow,” said Dr. David O'Malley, a gynecologic oncologist at The Ohio State University Comprehensive Cancer Center.
O'Malley was not involved in the new studies.
In one of the studies, researchers found that adding the immunotherapy drug pembrolizumab (commonly known by its brand name, Keytruda) to the standard chemotherapy regimen of carboplatin and paclitaxel reduced patients' risk of advanced or recurrent endometrial cancer. will return up to 70%, depending on the types of tumors they had.
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"We found a profound improvement," said the study's lead author, Dr. Carol Aghajanian, a medical oncologist specializing in gynecologic cancers at Memorial Sloan Kettering Cancer Center in New York.
Some patients in the study who received the combination treatment spent, on average, more than a year (13.1 months) before their disease progressed, compared with 8.7 months, on average, among those who received chemotherapy alone.
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The impact was most dramatic in women with a mismatch repair-deficient tumor, a specific type of endometrial cancer.
While women in the chemotherapy-only group spent an average of 7.6 months before their cancer progressed, women with the mismatch repair-deficient tumor type who received chemotherapy plus immunotherapy are doing just as well a year later, that there has not been enough tumor progression for researchers to determine how long the benefits might last.
Dr. Pamela Soliman, a gynecologic oncologist at the MD Anderson Cancer Center in Houston who was not involved in the new studies, said the results were interesting.
“Patients with advanced or recurrent endometrial cancer don't have many opportunities for treatment.
This does change practice,” Soliman said.
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Currently, immunotherapy is only approved for endometrial cancer as a second line of treatment, after chemotherapy.
These findings suggest a significant advantage in the use of immunotherapy as part of the first line of treatment in these advanced cancers.
The Food and Drug Administration (FDA) would have to modify its guidelines on the use of immunotherapy in this way before it becomes widespread as a treatment protocol for late-stage endometrial cancer.
According to Aghajanian, regulators are already studying the new data.
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Women are not screened for endometrial cancer.
It is usually detected when symptoms appear.
The most common symptoms are postmenopausal bleeding or other irregular vaginal bleeding.
The American Cancer Society estimates that 66,200 cases of endometrial cancer will be diagnosed this year and that more than 13,000 women will die from the disease.
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The rate of new endometrial cancers has increased by 0.6% a year between 2010 and 2019, according to the National Cancer Institute.
A second study published Monday compared chemotherapy with combination chemotherapy therapy that included a monoclonal antibody called dostarlimab.
Again, depending on the type of endometrial tumor, the risk of the cancer coming back was reduced by up to 61.4% for up to two years after treatment.
Both studies were welcomed by doctors frustrated by the rise in endometrial cancer cases.
“Endometrial cancer is one of the few cancers with increasing mortality in the United States,” Aghajanian says.
"Unfortunately, very few specific treatments have been developed for it," she added.