Opinion statement
Among gynecologic malignancies, mismatch repair–deficient endometrial cancers show the greatest response to anti-programmed cell death-1 (PD-1) antibodies, such as pembrolizumab. Routine immunohistochemical (IHC) and molecular testing should be performed on all endometrial cancers at the time of diagnosis in order to identify endometrial cancers with mismatch repair deficiency that may show improved response to anti-PD-1 therapy in the progressive or metastatic setting. Institutional effort to enroll patients in clinical trials investigating the use of immune checkpoint inhibitors in endometrial cancer should be prioritized.
Similar content being viewed by others
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Gadducci A, Guerrieri ME. Immune checkpoint inhibitors in gynecological cancers: update of literature and perspectives of clinical research. Anticancer Res. 2017;37(11):5955–65.
•• Le DT DJN, Smith KN, Wang H, Bartlett BR, Aulakh LK, et al. Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade. Science. 2017;357(6349):409–13. Phase II study of pembrolizumab highlighting the reponse of MSI-high cancers to PD-1 blockade.
Ventriglia J, Paciolla I, Pisano C, Cecere SC, Di Napoli M, Tambaro R, et al. Immunotherapy in ovarian, endometrial and cervical cancer: state of the art and future perspectives. Cancer Treat Rev. 2017;59:109–16.
Lee L, Gupta M, Sahasranaman S. Immune checkpoint inhibitors: an introduction to the next-generation cancer immunotherapy. J Clin Pharmacol. 2016;56(2):157–69.
Wolchok JD, Hodi FS, Weber JS, Allison JP, Urba WJ, Robert C, et al. Development of ipilimumab: a novel immunotherapeutic approach for the treatment of advanced melanoma. Ann N Y Acad Sci. 2013;1291(1):1–13.
Jin H-T, Ahmed R, Okazaki T. Role of PD-1 in regulating T-cell immunity. Negative co-receptors and ligands: Springer; 2010. p. 17–37.
Ribas A, Hamid O, Daud A, Hodi FS, Wolchok JD, Kefford R, et al. Association of pembrolizumab with tumor response and survival among patients with advanced melanoma. Jama. 2016;315(15):1600–9.
Garon EB, Rizvi NA, Hui R, Leighl N, Balmanoukian AS, Eder JP, et al. Pembrolizumab for the treatment of non–small-cell lung cancer. N Engl J Med. 2015;372(21):2018–28.
Bellmunt J, De Wit R, Vaughn DJ, Fradet Y, Lee J-L, Fong L, et al. Pembrolizumab as second-line therapy for advanced urothelial carcinoma. N Engl J Med. 2017;376(11):1015–26.
Plimack ER, Bellmunt J, Gupta S, Berger R, Chow LQ, Juco J, et al. Safety and activity of pembrolizumab in patients with locally advanced or metastatic urothelial cancer (KEYNOTE-012): a non-randomised, open-label, phase 1b study. Lancet Oncol. 2017;18(2):212–20.
Balar A, Bellmunt J, O’donnell P, Castellano D, Grivas P, Vuky J, et al. Pembrolizumab (pembro) as first-line therapy for advanced/unresectable or metastatic urothelial cancer: preliminary results from the phase 2 KEYNOTE-052 study. Eur Soc Med Oncol. 2016.
Adams S, Schmid P, Rugo HS, Winer EP, Loirat D, Awada A, et al. Phase 2 study of pembrolizumab (pembro) monotherapy for previously treated metastatic triple-negative breast cancer (mTNBC): KEYNOTE-086 cohort A. Am Soc Clin Oncol. 2017.
Varga A, Piha-Paul SA, Ott PA, Mehnert JM, Berton-Rigaud D, Johnson EA, et al. Antitumor activity and safety of pembrolizumab in patients (pts) with PD-L1-positive advanced ovarian cancer: interim results from a phase Ib study. Am Soc Clin Oncol. 2015.
Garcia C, Ring KL. The role of PD-1 checkpoint inhibition in gynecologic malignancies. Curr Treat Options in Oncol. 2018;19(12):70.
Dudley JC, Lin M-T, Le DT, Eshleman JR. Microsatellite instability as a biomarker for PD-1 blockade. Clin Cancer Res. 2016;22(4):813–20.
Boland CR, Thibodeau SN, Hamilton SR, Sidransky D, Eshleman JR, Burt RW, et al. A National Cancer Institute Workshop on Microsatellite Instability for cancer detection and familial predisposition: development of international criteria for the determination of microsatellite instability in colorectal cancer: AACR; 1998.
Hegde M, Ferber M, Mao R, Samowitz W, Ganguly A. ACMG technical standards and guidelines for genetic testing for inherited colorectal cancer (Lynch syndrome, familial adenomatous polyposis, and MYH-associated polyposis). Genet Med. 2014;16(1):101.
Le DT, Uram JN, Wang H, Bartlett BR, Kemberling H, Eyring AD, et al. PD-1 blockade in tumors with mismatch-repair deficiency. N Engl J Med. 2015;372(26):2509–20.
Overman MJ, McDermott R, Leach JL, Lonardi S, Lenz H-J, Morse MA, et al. Nivolumab in patients with metastatic DNA mismatch repair-deficient or microsatellite instability-high colorectal cancer (CheckMate 142): an open-label, multicentre, phase 2 study. Lancet Oncol. 2017;18(9):1182–91.
Levine DA, Network CGAR. Integrated genomic characterization of endometrial carcinoma. Nature. 2013;497(7447):67.
Mills AM, Liou S, Ford JM, Berek JS, Pai RK, Longacre TA. Lynch syndrome screening should be considered for all patients with newly diagnosed endometrial cancer. Am J Surg Pathol. 2014;38(11):1501.
McConechy M, Talhouk A, Li-Chang H, Leung S, Huntsman D, Gilks C, et al. Detection of DNA mismatch repair (MMR) deficiencies by immunohistochemistry can effectively diagnose the microsatellite instability (MSI) phenotype in endometrial carcinomas. Gynecol Oncol. 2015;137(2):306–10.
Chang L, Chang M, Chang HM, Chang F. Microsatellite instability: a predictive biomarker for cancer immunotherapy. Appl Immunohistochem Mol Morphol. 2018;26(2):e15–21.
Yamashita H, Nakayama K, Ishikawa M, Nakamura K, Ishibashi T, Sanuki K, et al. Microsatellite instability is a biomarker for immune checkpoint inhibitors in endometrial cancer. Oncotarget. 2018;9(5):5652.
• Ott PA, Bang Y-J, Berton-Rigaud D, Elez E, Pishvaian MJ, Rugo HS, et al. Safety and antitumor activity of pembrolizumab in advanced programmed death ligand 1–positive endometrial cancer: results from the KEYNOTE-028 study. J Clin Oncol. 2017;35(22):2535–41. https://doi.org/10.1200/jco.2017.72.5952. Phase II study highlighting the use of pembrolizumab in endometrial cancer.
Konstantinopoulos PA, Liu JF, Barry WT, Krasner CN, Buss MK, Birrer MJ, et al. Phase 2, two-group, two-stage, open-label study of avelumab in patients with microsatellite stable, microsatellite instable and POLE-mutated recurrent or persistent endometrial cancer. J Clin Oncol. 2017;35(15_suppl):TPS5615-TPS. https://doi.org/10.1200/JCO.2017.35.15_suppl.TPS5615.
Konstantinopoulos PA, Liu JF, Luo W, Krasner CN, Ishizuka JJ, Gockley AA, et al. Phase 2, two-group, two-stage study of avelumab in patients (pts) with microsatellite stable (MSS), microsatellite instable (MSI), and polymerase epsilon (POLE) mutated recurrent/persistent endometrial cancer (EC). J Clin Oncol. 2019;37(15_suppl):5502. https://doi.org/10.1200/JCO.2019.37.15_suppl.5502.
FDA approves first cancer treatment for any solid tumor with a specific genetic feature. US Food and Drug Administration. . https://www.fda.gov/news-events/press-announcements/fda-approves-first-cancer-treatment-any-solid-tumor-specific-genetic-feature.
Koh W-J, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, et al. Uterine neoplasms, version 1.2018, NCCN Clinical Practice Guidelines in Oncology. 2018;16(2):170. https://doi.org/10.6004/jnccn.2018.0006.
Frenel J-S, Tourneau CL, O’Neil B, Ott PA, Piha-Paul SA, Gomez-Roca C, et al. Safety and efficacy of pembrolizumab in advanced, programmed death ligand 1–positive cervical cancer: results from the phase Ib KEYNOTE-028 trial. J Clin Oncol. 2017;35(36):4035–41. https://doi.org/10.1200/jco.2017.74.5471.
Gunderson CC, Matulonis U, Moore KN. Management of the toxicities of common targeted therapeutics for gynecologic cancers. Gynecol Oncol. 2018;148(3):591–600.
Brahmer JR, Lacchetti C, Schneider BJ, Atkins MB, Brassil KJ, Caterino JM, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol Off J Am Soc Clin Oncol. 2018;36(17):1714.
Friedman CF, Proverbs-Singh TA, Postow MA. Treatment of the immune-related adverse effects of immune checkpoint inhibitors: a review. JAMA Oncol. 2016;2(10):1346–53.
•• Thompson JA, Schneider BJ, Brahmer J, Andrews S, Armand P, Bhatia S, et al. Management of immunotherapy-related toxicities, version 1.2019, NCCN Clinical Practice Guidelines in Oncology. 2019;17(3):255. https://doi.org/10.6004/jnccn.2019.0013. NCCN Guidelines for management of immune therapy-related toxicities.
Liu YL, Zamarin D. Combination immune checkpoint blockade strategies to maximize immune response in gynecological cancers. Curr Oncol Rep. 2018;20(12):94.
Makker V, Rasco D, Vogelzang NJ, Brose MS, Cohn AL, Mier J, et al. Lenvatinib plus pembrolizumab in patients with advanced endometrial cancer: an interim analysis of a multicentre, open-label, single-arm, phase 2 trial. Lancet Oncol. 2019.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Janelle Sobecki-Rausch declares that there is no conflict of interest. Lisa Barroilhet declares that there is no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Gynecologic Cancers
Rights and permissions
About this article
Cite this article
Sobecki-Rausch, J., Barroilhet, L. Anti-programmed Death-1 Immunotherapy for Endometrial Cancer with Microsatellite Instability–High Tumors. Curr. Treat. Options in Oncol. 20, 83 (2019). https://doi.org/10.1007/s11864-019-0679-5
Published:
DOI: https://doi.org/10.1007/s11864-019-0679-5