The Revolution of Immunotherapy in Gynecological Cancers: The Lazarus Effect in Endometrial Cancer
Monika Ducceschi, Maggie Polignano, Marta Bini, Salvatore Lopez, Elena Conca, Elena Tamborini, Federica Perrone, Giulia Carlo Stella, Maria Cristina Petrella, Rosaria Carciotto, Grazia Artioli, Valeria Maffeis, Lucia Sartor, Francesco Raspagliesi, Mara Mantiero- General Medicine
Patients with solid tumors and mismatch repair deficiency (dMMR) or microsatellite instability-high (MSI-H) are eligible for immunotherapy. Recently, different reports described patients with poor performance status (PS), unrelated to comorbidities, which showed a rapid improvement of their clinical conditions under immunotherapy, which evoked a Lazarus response. Very few data on the efficacy and safety of immunotherapy in patients with gynecological malignancies and poor PS are available. Based on the GARNET trial, Dostarlimab, a monoclonal antibody anti-programmed death receptor-1 (PD-1), has been approved in advanced or recurrent mismatch repair deficient endometrial cancer (EC) which progressed after platinum-based therapy. For the first time, in gynecological oncology, an immune checkpoint inhibitor drastically changed the clinical practice. We collected a multicenter case series of six patients with advanced endometrial carcinoma and PS ECOG 3–4 treated with Dostarlimab, showing exceptionally quick responses and significant improvement of PS to configure a Lazarus response.