Pembrolizumab combined with chemotherapy for advanced and recurrent endometrial cancer: A single-center retrospective study.

BACKGROUND/PURPOSE: Immune checkpoint inhibitors have clinical benefits in patients with advanced or recurrent endometrial cancer, particularly those with deficient mismatch repair (dMMR) status. However, real-world data on the efficacy of the combination of pembrolizumab and chemotherapy in Asian populations remain scant.

METHODS

This retrospective, single-center study enrolled 98 Asian patients with stage III to IVB or recurrent endometrial cancer treated at National Taiwan University Hospital between January 2022 and February 2025. The patients received either carboplatin-paclitaxel alone or in combination with pembrolizumab. The pimary outcomes were progression-free survival (PFS) and overall survival (OS). The secondary outcomes included adverse events (AEs). Subgroup analyses based on mismatch repair status and pembrolizumab dose (100 mg vs. 200 mg) were conducted.

RESULTS

The rates of disease progression (12.5 % vs. 28.8 %) and mortality (3.1 % vs. 12.1 %) were lower in the pembrolizumab group than in the chemotherapy alone group. Multivariate analysis revealed a trend toward improved PFS for pembrolizumab treatment (hazard ratio [HR] 0.36; p = 0.08) and a significant interaction with mismatch repair status (HR 0.13; p = 0.05). AEs-including rash, myalgia, and autoimmune thyroid disease-occurred more frequently in the pembrolizumab group. No significant differences in efficacy or AEs were found between the two pembrolizumab dosing groups.

CONCLUSION

Pembrolizumab combined with chemotherapy may provide clinical benefits, particularly in patients with dMMR status, as the first-line treatment for endometrial cancer. Lower dosing may also be feasible in Asian populations, although further validation is warranted.