Learn The BasicsSeveral therapeutic options exist for endometrial cancer (EC). These include chemotherapy, hormonal therapy, targeted therapy and immunotherapy.
Chemotherapy
Chemotherapy refers to the use of drugs to kill cancer cells or prevent them from growing. It is usually used in case of advanced disease or if the cancer has come back after treatment.
Chemotherapy can be given by mouth or intravenously.
Patients may be treated with one or more chemotherapy agents at the same time.
Chemotherapy agents used to treat EC may include paclitaxel, carboplatin, cisplatin, doxorubicin or liposomal doxorubicin, bevacizumab, docetaxel and gemcitabine.
Chemotherapy can lead to side effects such as nausea and vomiting, loss of appetite, mouth sores, neuropathy, hair loss and hearing loss.
Hormonal therapy
Hormonal therapy refers to the use of drugs to lower the levels of hormones that cancer cells need to grow and spread. It is typically used in the case of advanced or recurrent disease.
The primary hormonal therapy for EC is progestins. Other hormonal therapies may include aromatase inhibitors, tamoxifen, fulvestrant and CDK 4/6 inhibitors.
The side effects of hormonal therapy may include hot flashes, night sweats, weight gain, worsening of depression, mood changes, vaginal dryness, joint and muscle pain, nausea, vomiting, headache, mouth sores and hair loss.
Targeted therapy
Targeted therapy refers to the use of drugs designed to interfere with specific molecular pathways that cancer cells use to grow, divide, or avoid the immune system.
Targeted therapy is usually used together with chemotherapy in the case of advanced EC.
Targeted therapies for EC include trastuzumab, fam-trastuzumab deruxtecan, lenvatinib, bevacizumab, everolimus, temsirolimus, cabozantinib, larotrectinib and entrectinib.
The side effects of targeted therapy may include fever and chills, tiredness and weakness, shortness of breath, cough, loss of appetite, joint and muscle pain, mouth sores, stomach pain, nausea and vomiting, diarrhea or constipation, weight loss, headache, low blood cell counts, bleeding, hair loss, high blood pressure, swelling in the arms and legs, rash, high blood sugar and cholesterol levels and abnormal liver test results.
Immunotherapy
The goal of immunotherapy is to trigger the body’s own immune system to attack the cancer cells.
Immunotherapy is considered in advanced cases of EC if other therapies have not been successful.
The primary immunotherapy used to treat EC is immune checkpoint inhibitors. Immune checkpoints are a normal part of the immune system to ensure that it does not attack healthy cells and tissues. Some cancer cells use this mechanism to evade the immune system. For example, they express proteins on their surface called programmed death ligand 1 or PD-L1 that bind to the programmed death 1 (PD-1) protein found on the surface of a specialized immune cell called T-cells to turn down its activity.
Immune checkpoint inhibitors can either bind to PD-1 or PD-L1 to break the bond between the two and allow the T-cell to “wake up” and recognize and attack the cancer cells.
Immunotherapy agents that target PD-1 used in EC include pembrolizumab, dostarlimab and nivolumab. Those that inhibit PD-L1 include durvalumab and avelumab.
The side effects of immune checkpoint inhibitors include tiredness and weakness, fever, cough, nausea, itching, rash, loss of appetite, muscle and joint pain, shortness of breath and constipation or diarrhea.