Immune Environment and Immunotherapy in Endometrial Carcinoma and Cervical Tumors

Endometrial (EC) and cervical cancers (CC) do not respond well to chemotherapy and alternative therapeutic options are lacking. Recently, EC and CC patients' outcome were improved thanks to immunotherapy-based treatments leading to their approval in the management of these diseases. However, not all patients respond to such treatments, especially in relapsed settings. In the present review, we focused on the immunological features of both EC and CC and presented the upcoming clinical trials targeting the immune system alone or in combination that will allow to improve patient's care. We also raise some questions that need to be solved in this field and presented the expected progresses.Abstract: Endometrial cancer (EC) is the seventh most common tumor in women, and prognosis of recurrent and metastatic disease is poor. Cervical cancer (CC) represents the fifth most common gynecological cancer. While ECs are more common in developed countries, the incidence of CC has decreased due to the recent implementation of large screening and vaccination programs. Until very recently, patients with advanced or unresectable EC or CC had very limited treatment options and were receiving in first line setting platinum/taxane-based chemotherapy (CT). Significant progress in the treatment of gynecological cancers has occurred in the last few years, with the use of innovative targeted therapies and immunotherapy. However, targeting the immune system in patients with gynecological tumors remains challenging and is not always successful. In ovarian cancer, several immunotherapy treatment regimens have been investigated (as monotherapy and combination therapy in first and subsequent lines of treatment) and showed poor responses. Therefore, we specifically focused our review on EC and CC for their specific immune-related features and therapeutic results demonstrated with immunotherapy. We report recent and current immunotherapy-based clinical trials and provide a review of emerging data that are likely to impact immunotherapy development based on increased biomarkers' identification to monitor response and overcome resistance.

Automated summary

Endometrial and cervical cancers have traditionally been difficult to treat with chemotherapy, and there is a need for alternative therapeutic options. Recently, immunotherapy-based treatments have shown promise in improving outcomes for these types of cancers. However, not all patients respond to immunotherapy, especially in cases of relapse. This review focuses on the immunological features of endometrial and cervical cancers, as well as upcoming clinical trials targeting the immune system to improve patient care. The review also raises important questions that need to be addressed in this field.