Study data highlights significant advances for women with advanced-stage cancer at diagnosis and for those who relapse by adding an immunotherapy drug to standard chemotherapy
If diagnosed and treated at an early stage, the prognosis of endometrial cancer is good: approximately 90-95% of patients are alive 5 years after diagnosis. For years, however, researchers have been working to find effective new treatments for women with advanced-stage cancer and for those who relapse after first-line therapy. Good news in this direction comes from a study presented during the annual congress on female tumors, organized by the American Society of Gynecologic Oncology in Tampa, Florida, and simultaneously published in the scientific journal New England Journal of Medicine
: immunotherapy, combined with standard chemotherapysignificantly reduces the risk of tumor progression and patient death.
The new experiment
The results of the phase three trial (the last one, before the official authorization of a drug) RUBY indicate, in fact, that with the addition of the immunotherapy drug dostarlimab to chemo (based on carbonplatinum and paclitaxel), compared to the current standard of care based on chemotherapy alone, significantly improves disease-free survival in women with already advanced or recurrent endometrial cancer and, in particular, in those with a specific genetic condition known as microsatellite instability. Specifically, the study compared the use of dostarlimab plus standard chemotherapy followed by dostarlimab versus chemotherapy plus placebo followed by placebo. The results show a 72% reduction in the risk of disease progression and a 36% decrease in the risk of death. The results, especially in view of the difficult-to-treat histologies included in the study (i.e. those with microsatellite instability), demonstrate that this may be the new standard of treatment: Adding immunotherapy to chemo comments Lorusso Sundayassociate professor of Obstetrics and gynecology and head of clinical research programming at the Irccs Foundation Gemelli University Hospital in Rome.
Symptoms not to be overlooked
In Italy there are approx 10 thousand new diagnoses every year of endometrial cancer, the fourth most frequent cancer in the female population after those a breast, colon and lung. The higher incidence in women of menopausal age: it occurs above all around the age of 55-65 (average age 60 years) and only in 20% of cases before menopause has begun; in fact rare before the age of 40. Metrorrhagia, or abnormal uterine bleeding regardless of menstrual cycle or post-menopausal, the first alarm bell: for this reason, blood losses, especially in post-menopausal women, should be a reason for rapid and thorough investigation. yellowish-white vaginal discharge (leucoxantorrhea), abdominal pain and swelling (edema) of the lower limbs are instead more characteristic of an advanced stage neoplasm. About 3,000 Italians die each year from this neoplasm which, being considered to have a good prognosis, has not seen major investments in research and treatment – continues Lorusso -. The consequence that today it is the only oncological pathology with increasing mortality. In 80% of cases the diagnosis occurs when confined within the uterus, but in the recurrence, in an advanced form, the median survival is three years. Until yesterday we only had chemotherapy with carboplatin and taxol.
Who is most at risk of getting sick
The big bet of the RUBY study was that immunotherapy could boost chemotherapy,” he adds George Valabrega, associate professor of medical oncology at the University of Turin and at the Irccs Candiolo and coordinator for Italy of the trial —. The statistical design of the complex trial, with two objectives: demonstrate progression-free survival and the global one, first analyzing the patients who, due to genetic issues, having microsatellite instability (dMMR/MSI-H), were more “ready” to therapy, and then extending it to all the others. The results are truly relevant, with results never seen before. Now we ask ourselves the question of whether chemo is needed for everyonewhen only immunotherapy is needed, what to do in patients who progress, in those who do not respond to therapies. There are other studies in progress on these points and we expect to be able to have answers in about a year and a half. Obesity, diabetes, hypertension, late menopause, intake of estrogens not balanced by progestogens increase the probability of getting sick. The risk is also higher for women who take tamoxifena drug used in breast cancer therapy, and who received it previous radiation therapy on the pelvis – concludes Valabrega -. The reason behind the increased danger for these categories of people lies in theincreased amount of estrogen which, in all these cases, stimulates the endometrium in an improper way.
March 31, 2023 (change March 31, 2023 | 07:21)
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