Long considered a minor tumor because it is easily identifiable and often resolvable with surgery, endometrial cancer has remained the Cinderella of female tumors for years. Thus, also due to the lengthening of average life, today it is the 4th most frequent cancer in the female population (after breast, colon and lung) and is constantly increasing. In Italy there are 117 thousand women diagnosed with endometrial cancer and every year 10 thousand new cases are recorded, 90% of which are women over 50 years old.
The sign that allows you to identify endometrial cancer is abnormal vaginal bleeding, i.e. blood loss in post menopause or in fertile age between two menstrual periods, following sexual intercourse, in irregular cycles that are abundant and longer than normal . This allows, in the vast majority of cases, to diagnose it at an early stage and proceed with surgery, possibly followed by chemo or radiotherapy, to achieve recovery.
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Immunotherapy for difficult cases
However, there are cases in which the disease recurs or the diagnosis occurs already at an advanced stage. “And it is for these patients that we can today talk about results that until a few years ago were unthinkable, thanks to immunotherapy – he explains Ketta Lorussohead of Medical Gynecology Oncology at Humanitas San Pio
The results are those of the Ruby study presented in recent days at the annual meeting of the Society of Gynecologic Oncology on Women’s Cancer which took place in San Diego. The data speak clearly: the addition of the molecule that acts on the immune system to standard chemo reduces the risk of death by 31% and leads to a clinically significant improvement of 16.4 months in overall survival across the entire population studied.
An advantage for all patients
“Last year it was demonstrated that the addition of dostarlimab to chemotherapy led to an improvement in progression-free survival compared to chemotherapy alone in a specific group of patients, those who present the so-called microsatellite instability, a genetic defect due to alterations that affect the system that should repair DNA. Data that has led to the approval of this immunotherapy as a first-line treatment in combination with chemo for the advanced phase of the disease. “Today, however, these additional data open up a new scenario because they indicate that the advantage is for all patients. We hope that in the near future the indication can be extended so that all patients can benefit from this therapy”, underlines Lorusso.
Therapies that act on the immune system produce a long-lasting effect, because they modify the so-called tumor microenvironment, i.e. the complex network of biochemical signals that are exchanged around the diseased cells. This is why, in women whose cancer responds well to therapy with dostarlimab, the response is maintained for a long time: three years after starting treatment, approximately 80% of patients with microsatellite instability are alive.
New strategies
At the American congress, other data were also presented on the addition of a third drug, niraparib, to the dostarlimab+chemo combo. The idea is to also target other mechanisms that contribute to tumor development, to try to increasingly improve the prognosis of difficult cases.
“The results are less mature and indicate that the addition improves disease-free survival especially for patients with microsatellite instability. This is a therapy for which a careful balance must be made between risks and benefits, also because our patients are fragile and have comorbidities – he explains Giorgio Valabregadirector of the SCDU Oncology of the Ordine Mauriziano Hospital of Turin – The combination alone, however, is well tolerated despite – as we have seen – really good results”.
In short, after years in which there were no new developments, today we can say that endometrial cancer is no longer the Cinderella of female oncology and that the immunotherapy revolution has allowed, in this case too, to see results up to a few unexpected year ago.