The Implementation of Immunotherapy in Patients With Endometrial Cancer
In this video, Anna Jo Smith, MD, MPH, MSc, discusses the use of two FDA-approved immunotherapy treatments for endometrial cancer in patients. She talks about health care disparities surrounding the delivery of immunotherapy treatments to patients, why gynecologists and oncologists should consider this method of treatment for eligible patients, and what the next steps are for research on this topic. Dr Smith presented her findings at The Society of Gynecologic Oncology (SGO) 2024 Annual Meeting in San Diego, California.
Additional Resource:
Smith AJ. Implementation of immunotherapy in recurrent endometrial cancer: A real-world study. Poster presented at: The Society of Gynecologic Oncology (SGO) 2023 Annual Meeting on Women’s Cancer; March 16-18, 2024; San Diego, CA. Accessed March 7, 2024. www.sgo.org/events/annual-meeting/
For more SGO 2024 coverage, visit the Newsroom.
TRANSCRIPTION:
Anna Jo Smith, MD, MPH, MSc: I am Anna Jo Smith, I am a gynecologic oncologist at the University of Pennsylvania. My research focuses on cancer care delivery in GYN cancers and how we can improve delivery of care to be equitable for all populations that develop GYN cancer and pre -cancer.
Consultant360: Please provide some background and an overview of your poster discussion as the SGO 2024 Meeting titled, “Implementation of immunotherapy and recurrent endometrial cancer: A real-world study.”
Dr Smith: We were interested in this topic for two reasons. One, immunotherapy, like in other cancers, has really changed the landscape and survival in endometrial cancer. We know that, first approved in 2017 with multiple landmark studies, immunotherapy improves overall survival, especially for patients with germline or somatic mismatch repair deficiency. So a really big win for cancer care. But at the same time we know that endometrial cancer has had significant disparities in delivery of care. We know that Black women with endometrial cancer are more likely to be diagnosed at a later stage and to die sooner of their disease, as well as we know there are significant disparities by insurance and by region as well in endometrial care delivery. So our interest was to look at whether implementation immunotherapy differed by patient’s socio-demographics with the goal that, if we understand where there are differences, how can we close the gap to deliver high-quality endometrial cancer care to all patients?
C360: How do the results of this study impact clinical practice?
Dr Smith: The main finding from this study is really that we're not using immunotherapy enough in endometrial cancer and that's probably the biggest lesson for everyone is that we've found that only one-third of patients with recurrent endometrial cancer, post-FDA approval, so this is a cohort of over 1,000 patients from 2017 to 2021, only a third were ever treated with immunotherapy. So we can do better as oncologists. We can get more immunotherapy to more patients. We also found that only two-thirds of patients were tested for mismatch repair deficiency. That means their cancer wasn't tested in one-third of patients and we lose the ability to prevent endometrial cancer in those patients' relatives if we identified a mismatch repair deficiency syndrome, such as Lynch syndrome. So we're A, missing the opportunity to get immunotherapy to patients who really could benefit, as well as missing the opportunity to test patients for mismatch repair deficiency, identify a germline genetic syndrome in the five to 10 percent of patients that have it, and prevent endometrial cancer in their relatives, as well as other cancers in those patients.
C360: Can you elaborate on what immunotherapy options your study looked at?
Dr Smith: Yeah, so in this paper, we're looking at the two drugs that have FDA approval in endometrial cancer. So first is pembrolizumab, sort of the oldest approved immunotherapy, first approved in 2017. And then the other thing that is approved and has improved survival in endometrial cancer is a combination of lenvatinib, which is a VEGF inhibitor, and pembrolizumab. So when we're talking about immunotherapy, I'm talking about use of either pembrolizumab alone or pembrolizumab with lenvatinib. And again, because so few patients overall had had exposure to these agents, we chose to combine pembrolizumab as well as the combo of lenvatinib and pembrolizumab in the analysis.
C360: What’s next for research on this topic?
Dr Smith: The good thing is that we didn't see disparities in terms of delivery of care. The only real disparity we saw that patients in the West were less likely to get immunotherapy.
We really just saw that we weren't using immunotherapy enough. One third of patients weren't getting immunotherapy. So the next steps is really a call to all oncologists—to medical, gynecologic—to really think about when you have a patient with recurrent endometrial cancer, to think about whether they're a good candidate for immunotherapy and to offer it to them.
C360: What are the overall take-home messages from this study and from our conversation today?
Dr Smith: The biggest thing is really we should use immunotherapy in more patients who are eligible for it. So really, that's two-thirds of patients who potentially are eligible for immunotherapy in recurrent endometrial cancer. We should think about, well, how do we get immunotherapy to those patients? Is it that we don't have mismatch repair testing, is that they don't have access to a cancer center that's using immunotherapy, which I would say is rarer and rarer these days. And so how do we sort of go that last mile of getting this drug that's FDA approved to all the patients that could benefit. So big takeaway for clinicians is to think about immunotherapy in recurrent endometrial cancer. And then we have lots of ongoing work about how you change practice patterns among clinicians to improve use of evidence-based care like immunotherapy and endometrial cancer, as well as how to educate patients and get health systems to cover these life-saving therapies.
Dr Smith: Thank you for listening to our work on immunotherapy and barriers in endometrial cancer. Takeaways from this are to think about immunotherapy in your current endometrial cancer patients. We can use it more, we can use it more efficiently, as well as to learn more about this and other exciting research that's going be presented at the Society for Gynecological Oncology in March 2024.