A Note on Endometrial Cancer Treatment

Serena Bertozzi^*
*Correspondence: Serena Bertozzi, Department of Medical Area, University of Udine, Italy, Email:

Commentary

The introduction of immunotherapy—drugs that target the body's immune system to attack cancer—has recently revolutionised cancer treatment. The majority of clinically used drugs inhibit the mechanisms that dampen immune response. Immune checkpoint inhibitors are the name given to these medications (ICIs). In gynaecological cancers, ICIs are most effective in treating uterine endometrial cancer, but less effective in treating ovarian, uterine cervical, or vulvar cancer. Combining ICIs with other drugs, on the other hand, has yielded promising results in some studies in these cancers. Stopping mechanisms that dampen immune response can have serious consequences, as seen with the use of ICIs. As a result, selecting patients who will benefit the most from ICI therapy is critical. This can be accomplished by examining tumour characteristics such as protein expression, genetic changes, and even the composition of faecal microbiota, which are referred to as biomarkers. It is unclear which biomarkers most accurately predict response, and this varies by cancer type.

The concept of activating the immune system against cancer dates back to William Coley's experiments in the nineteenth century, when he injected live or inactivated pathogens into tumours. However, until recently, modern oncological practises did not, at least not directly, take advantage of this mechanism. The introduction of oncological immunotherapy, most notably the development of a new class of systemic biological therapy directed at immune receptors and their ligands, known as immune check-point inhibitors, has revolutionised the field in the last ten years (ICIs).

These agents revolutionised the treatment of several solid tumours, including previously difficult-to-treat tumours like metastatic melanoma and non-small cell lung, urothelial, and kidney cancer. Several biomarkers for treatment response have been tested in clinical trials based on the mechanism of action of these agents, leading to regulatory approvals of ICIs based on the presence of these biomarkers. Furthermore, this has resulted in tissueagnostic approvals, in which an anticancer drug is approved based solely on the presence of a biomarker rather than its histology. Recently, trials of ICIs for gynaecological cancer have yielded promising results, particularly for endometrial and, to a lesser extent, uterine cervical carcinoma. Gynecological cancers are a diverse group of tumours, and their responses to ICIs can be predicted using a variety of biomarkers. However, the best biomarkers for each type of cancer have yet to be identified [1-5].

Endometrial cancer, the most common gynaecological cancer in the developed world, has an increasing incidence and prevalence, with an estimated 121,000 new cases and 30,000 deaths in Europe in 2018. Although patients diagnosed early have a good 5-year survival rate of 95%, patients diagnosed late have a dismal prognosis with a 5-year survival rate of only 17%. Until recently, the only options for patients with recurrent or metastatic disease were platinum-based chemotherapy and hormonal therapy. The median progression-free survival (PFS) and overall survival (OS) in the standard-of-care chemotherapy regimen used in first-line settings (carboplatin plus paclitaxel) were 13 and 37 months, respectively. Prior to the advent of immunotherapy and targeted therapy, the options for patients who progressed after first-line systemic chemotherapy were carboplatin plus paclitaxel retreatment, single-agent chemotherapy, or hormonal therapy; the median OS was generally 12 months.

References

1. Youssef, Hanan, Mansour M.A.M, Saeed Al-Zahrani, and Ibrahim Ayasrehal. “Prioritizing palliative care: Assess undergraduate nursing curriculum, knowledge, and attitude among nurses caring end-of-life patients.” 2 (2015): 90-101.

Google Scholar

2. Glasdam, Stinne, Frida Ekstrand, Maria Rosberg, and Ann-Margrethe van der Schaaf. “A gap between the philosophy and the practice of palliative healthcare: sociological perspectives on the practice of nurses in specialised palliative homecare.” Med Health Care Philos 23 (2020): 141-152.

Google Scholar, Crossref, Indexed at

3.  Kassa, Hiwot, Rajalakshmi Murugan, Fissiha Zewdu, and Mignote Hailu, et al. “Assessment of knowledge, attitude, and practice and associated factors toward palliative care among nurses working in selected hospitals, Addis Ababa, Ethiopia.” 13 (2014): 6.

Google Scholar, Crossref, Indexed at

4. Sorifa, Begum, and Khanam Mosphea. “Knowledge and practice of staff nurses on palliative care.” 1 (2015): 41-5.

Google Scholar, Crossref, Indexed at

5. Zeru, Teklay, Hagos Berihu, Hadgu Gerensea, and Girmay Teklay, et al. “Assessment of knowledge and attitude towards palliative care and associated factors among nurses working in selected Tigray hospitals, northern Ethiopia: a cross-sectional study.” 35 (2020): (121).

Google Scholar, Crossref, Indexed at