The role of immunotherapy in the management of metastatic/recurrent female reproductive system neoplasms

Author:

Rumyantsev A. A.1ORCID,Anokhin A. Yu.2ORCID

Affiliation:

1. Blokhin National Medical Research Center of Oncology

2. Blokhin National Medical Research Center of Oncology; Sklifosovsky Institute of Clinical Medicine

Abstract

In 2019 malignant neoplasms of the female reproductive system (ovarian cancer, (OC), endometrial carcinoma (EC) and cervical cancer (CC) were diagnosed in 58 860 patients – 17.6% of all malignant tumors in women in Russia. The morbidity and mortality rates from these neoplasms remain high over the past 10 years. This article provides a detailed review of the current evidence base for  the  use of  various immunotherapeutic agents in  mentioned malignant neoplasms. It has been demonstrated that in  relapsed OC (ROC), the  only proved indication for  immunotherapy is tumors with microsatellite instability (MSI), whereas PD-L1 does not have an independent role in this disease. MSI occurs in approximately 8% of patients with metastatic OC. A significantly higher frequency MSI — up to 25% is detected in metastatic EC. MSI-positive subtype of the disease is characterized by an extremely high sensitivity to immunotherapy - the  rate of  objective response with pembrolizumab exceeds 50%. For  MS-stable  EC, the  combination of  pembrolizumab and lenvatinib is an effective therapeutic option. In  advanced CC, on the other hand, PD-L1 has a predictive role for immunotherapy efficacy — the KEYNOTE-158 study showed that about 15% of  patients with extensively pretreated metastatic PD-L1-positive CC can achieve long-term remission with pembrolizumab compared to 0% in PD-L1 negative tumors. Current evidence shows that PD-L1 expression can be observed in ≥ 30% of patients.

Publisher

Remedium, Ltd.

Subject

General Medicine

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