Pembrolizumab for Endometrial Neoplasms

The following is from the American gynaecological pathology service (USA) (see reference list, 9[17]). The exact composition of the lesions is unknown. They usually have no or only vague signs of malignancy on light microscopy. An endometrial biopsy has to be performed, because the underlying histologies may differ significantly from benign lesions.

The American Cancer Society estimates 3,817 new diagnosed cases of the main invasive [endometrial cancer](https://www.withpower.com/clinical-trials/endometrial-cancer) subtypes will be made in 2020. This cancer will be the most common cause of cancer-related death in American women (1.7% of deaths will be caused an endometrial or endometrioid type of endometrial cancer) with an estimated 33,100 deaths.

Treatment options for endometrial neoplasms are dependent on the specific type of malignancy, but most treatments are aimed at eliminating either the abnormal blood supply, or the presence of the tumour. The goals of management for all cases are to relieve symptoms, eliminate recurrent bleeding, maintain fertility and control symptoms. A multidisciplinary tumour board will consider optimal management based on the tumour type, stage, location, grade, underlying cause, recurrence, metastatic spread and symptom control needs.

Although it has been demonstrated that endometrial neoplasms can be cured in select cases, this process is not guaranteed in all cases. However, if complete removal is possible (either through cure or total resection), many patients do well.

The causes of [endometrial cancer](https://www.withpower.com/clinical-trials/endometrial-cancer) are unknown, although some known aetiologic factors are discussed, some of which have been suggested in other cancers, such as tobacco smoking and endometrial atrophy.

Endometrial cancer has some of the same signs and symptoms as endometrial polyps. These include bleeding with menses or between periods, painless swollen lump, itching or a burning sensation with urination, and a change in vaginal bleeding.

The odds of developing endometrial neoplasms in a patient with a history of hysterectomy or adnexal cancer, pelvic surgery, and menarche less than 15 and more than 21 were greater than 10 and 5 times, respectively, those in the general population in this cohort. In a recent study, findings have ramifications for cancer control, as endometrial cancer screening should be offered.

The data suggest that advanced endometrial carcinoma is usually locally invasive but seldom multifocal and that infiltrative and lymphatic spread may have a limited impact on disease-specific mortality, because early spread does not confer an increased risk of late-stage disease. The data also indicate that the presence of uterine lymphadenopathy is an independently negative prognostic factor in early stage disease as well as in the presence of lymphadenopathy.

The overall incidence of endometrial cancer is rising, but there is not an increased proportion of menopausal patients with this disease. The most common symptom is abnormal vaginal bleeding, which is the most frequent reason for endometrial screening during the period of this study. Clinical trials evaluating the adjuvant effects of therapy with estrogen receptor antagonists or nonsteroidal anti-inflammatory drugs are worthwhile.

Advanced stage endometrial cancer represents an increased risk for recurrence and is associated with an increased risk for distant metastases and mortality. Endometrial cancer patients should be informed that they can expect adjuvant therapy with postoperative chemotherapy or radiotherapy and that recurrence and death can occur.

The current phase 3 trial on pembrolizumab in mHCC patients has been extended. More importantly, a pembrolizumab phase 2 trial with recurrent HCC is underway, and there have been two successful phase 2 trials regarding pembrolizumab as a companion therapy in combination with sorafenib in HCC patients.