David M. O’Malley, MD, spoke about unmet needs of patients with advanced microsatellite instability–¬high or mismatch repair deficient endometrial carcinoma and the clinical benefit pembrolizumab provides.
Pembrolizumab (Keytruda) was recently approved for patients with advanced endometrial carcinoma that is microsatellite instability high (MSI-H) or mismatch repair deficient (dMMR), based on results of the phase 2 KEYNOTE-158 trial (NCT02628067).1,2 CancerNetwork® spoke with David M. O’Malley, MD, director of the Division of Gynecologic Oncology at the Ohio State University Comprehensive Cancer Center-The James and professor in the Department of Obstetrics and Gynecology at The Ohio State University College of Medicine as well as lead investigator of the study, about which patient populations benefit most from this treatment and how the agent is helping to address unmet needs for these patients.
This is giving patients with recurrent metastatic uterine cancer an option which we could never have dreamed of prior to these checkpoint inhibitors. In the past, the options were quite limited in patients with recurrent uterine cancer, and there was no differentiation between [disease that was] MSI-H or dMMR deficient. This is a great step into personalized medicine and using the molecular changes within tumors to help us differentiate care and treatments.
The approval is for MSI-H and dMMR deficient disease, and those are clearly the patients which will benefit. Mismatch repair–proficient or MSI stable patients should not be treated with single-agent pembrolizumab. Those patients have an option of pembrolizumab plus lenvatinib [Lenvima] with immune therapies. It’s very important that we prescribe the proper therapies specifically to those patients who are MSI-H or dMMR deficient.