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Real-world use of immune checkpoint inhibitors in advanced or recurrent endometrial cancer
  1. Sarah Huepenbecker1,
  2. Larissa A Meyer1,
  3. Miranda Craft2,
  4. John K Chan3,
  5. Christopher Craggs2,
  6. Peter Lambert2 and
  7. Yvonne G Lin2
    1. 1Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
    2. 2Genentech Inc, South San Francisco, California, USA
    3. 3Sutter Health - Palo Alto Medical Foundation, Palo Alto, California, USA
    1. Correspondence to Dr Yvonne G Lin, Genentech Inc, South San Francisco, CA 94080, USA; lin-liu.yvonne{at}gene.com

    Abstract

    Objective The aim of this study was to describe real-world use of immune checkpoint inhibitors for women with advanced or recurrent endometrial cancer.

    Methods Adult women with advanced or recurrent endometrial cancer who received at least one line of systemic treatment between January 1, 2014 and November 1, 2020, then followed to May 31, 2021 in a nationwide electronic health record-derived de-identified database. Chi-Squared test or Welch’s 2-sample t-tests were used to compare patient and clinical factors associated with immune checkpoint inhibitor treatment. Time to next treatment analyses were performed based on the treatment line of the immune checkpoint inhibitor. Sankey plots depicted patient-level temporal systemic treatment.

    Results During our study period, 326 women received their first immune checkpoint inhibitor treatment, increasing from 12 patients in 2016 to 148 in 2020. Factors associated with ever receiving immune checkpoint inhibitors included disease stage (p=0.002), mismatch repair (MMR)/microsatellite instability (MSI) status (p<0.001), performance status (p=0.001), and prior radiation receipt (p<0.001) and modality (p=0.003). The most common immune checkpoint inhibitor regimen was pembrolizumab (47.9%) followed by pembrolizumab and lenvatinib (34.7%). Immune checkpoint inhibitors were given as first, second, and third or greater lines of therapy in 24.5%, 41.7%, and 46.1% of evaluable patients. The median time to next treatment was significantly longer if given as an earlier line of treatment (p=0.008). There were significant differences in treatment line of immune checkpoint inhibitor by region (p=0.004), stage (p<0.001), and prior radiation receipt (p=0.014) and modality (p=0.009). Among 326 patients who received immune checkpoint inhibitors, 114 (34.9%) received subsequent treatment including chemotherapy (43.9%), additional immune checkpoint inhibitors (29.8%), and other (26.3%) with no differences in demographic or clinical characteristics based on the type of post-immune checkpoint inhibitor treatment.

    Conclusion In an observational retrospective real-world database study, immune checkpoint inhibitors were used in 14.7% of patients with advanced or recurrent endometrial cancer across multiple lines of treatment, including after initial immune checkpoint inhibitor treatment.

    • Uterine Cancer
    • Immunotherapy

    Data availability statement

    Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a selected team by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

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    Data availability statement

    Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a selected team by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

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    Footnotes

    • X @sarah_huep

    • Contributors SH: Conceptualization, data curation, formal analysis, investigation, validation, visualization, Roles/Writing: original draft. LAM: Formal analysis, investigation, validation, visualization, supervision, Roles/Writing: review and editing. MC: Conceptualization, data curation, formal analysis, Roles/Writing: original draft. JKC: Formal analysis, investigation, supervision, validation, visualization, Roles/writing: review and editing. CC: Data curation, formal analysis, methodology, supervision, validation, visualization, Roles/Writing: original draft. PL: Data curation, formal analysis, methodology, validation, visualization, Roles/Writing: original draft. YGL: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, validation, visualization, Roles/Writing: original draft. Guarantor: All authors drafted or reviewed the manuscript for important intellectual content, approved the final version of the manuscript for publication, and agree to be accountable for all aspects of the work. YGL is guarantor of the study.

    • Funding This study was sponsored by F. Hoffmann-La Roche Ltd.

    • Competing interests SH reports research support from the NIH T32 training grant (CA101642). LAM reports research funding for unrelated work from AstraZeneca and Merck, has stock options from Crispr, Bristol Meyers Squibb, Denali, Invitae, Johnson & Johnson and reports a grant from the National Cancer Institute. JKC reports funding (to institution) for the present work from the Denis Cobb Hale Chair funds, The Fisher Family Fund, Angela Wang Johnson Fund; grants or contracts (to institution) from GlaxoSmithKline, Immunogen, Karyopharm; consultancy fees from AstraZeneca, GlaxoSmithKline, Genmab/Seagen, Immunogen, Karyopharm, Merck, Mersana, Myriad, Roche; honoraria and travel support from AstraZeneca, Eisai, Genmab/Seagen, GlaxoSmithKline, Immunogen, Merck, Myriad; participation on a data safety monitoring board/advisory board with AstraZeneca, GlaxoSmithKline, Myriad. MC, CC, PL, and YGL are employed by Genentech, Inc. and have stock/share options in F. Hoffmann-La Roche Ltd/Genentech, Inc.

    • Provenance and peer review Not commissioned; externally peer reviewed.