Dr Wagar on the Role of Adjuvant Immunotherapy in Endometrial Cancer

“The integration of immunotherapy into the adjuvant treatment realm really drives home the importance of staging and having access to someone who’s capable [of performing] these staging procedures for these patients. There [are] some mixed data for using immunotherapy in patients that have early-stage disease or disease that is not necessarily very high risk for recurrence, [suggesting that] maybe [immunotherapy is] not as efficacious [in that population] as [it is for] some of these more high-risk patients.”

Matthew Wagar, MD, gynecologic oncology fellow, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, discusses the role of immunotherapy in the adjuvant treatment of patients with endometrial cancer and underscores the importance of accurate staging in optimizing therapeutic outcomes.

The integration of immune checkpoint inhibitors into the adjuvant setting has shown clinical benefit in patients with endometrial cancer, particularly in those with high-risk disease. However, Wagar notes that data on the efficacy of immunotherapy in early-stage or lower-risk endometrial cancer remain mixed. This underscores the need for comprehensive risk stratification, facilitated by precise staging techniques such as sentinel lymph node mapping and, when indicated, full lymphadenectomy with pelvic and para-aortic lymph node dissection.

Accurate staging provides essential prognostic information that can guide treatment selection, particularly given the significant survival benefit associated with immunotherapy in patients with adequately staged, high-risk disease. Additionally, molecular characterization, including mismatch repair (MMR) status, further refines patient selection. Wagar notes that patients with MMR-deficient tumors have demonstrated substantial responses to immune checkpoint inhibitors, reinforcing the need for early biomarker identification.

Beyond staging, Wagar also explains that patient-specific factors including medical comorbidities, surgical risk, and overall functional status must be carefully considered when incorporating immunotherapy into adjuvant treatment strategies. Collaboration with pathologists to obtain comprehensive molecular data is critical, particularly for patients who are not surgical candidates or who present with advanced or recurrent disease.

Wagar also notes that although immunotherapy is indicated for a broad range of patients, its effect is most pronounced in those with MMR-deficient tumors and high-risk features. Ensuring optimal staging and molecular characterization at diagnosis is critical for maximizing therapeutic benefit. He concludes that continued research and refinement of treatment algorithms will further clarify the role of immunotherapy in early-stage disease while reinforcing its established efficacy in high-risk endometrial cancer.