Immunotherapy combined with chemotherapy has become the first-line standard for patients with advanced or recurrent endometrial cancer, and a commentary published in The Lancet now asks whether the chemotherapy component is still needed for one important subgroup. The authors focus on mismatch repair-deficient tumors, known as dMMR, which make up roughly a quarter of these cases.
The current standard adds a PD-1 or PD-L1 inhibitor to the long-used combination of carboplatin and paclitaxel. For patients with dMMR tumors, that addition has transformed first-line care, giving them far better odds of holding their disease back than the older chemotherapy approach alone.
Several large trials, including RUBY, NRG-GY018, AtTEnd and DUO-E, tested this combination and reported progression-free survival hazard ratios between 0.28 and 0.42 in the dMMR groups, a strong signal of benefit. The four-year follow-up from RUBY also suggests that some patients may be cured, a result that has encouraged clinicians to look more closely at what each drug contributes.
The gap, the commentary argues, is that every one of these trials kept chemotherapy in the regimen. No study has tested whether dMMR patients could receive the immunotherapy alone, so it remains unknown whether chemotherapy can be dropped without losing benefit. Answering that question would require a dedicated trial, and until one is run, chemotherapy stays part of the standard approach for these patients.
Credit. Based on reporting for The Lancet. Is this your work? Write to us.
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