Advancing Care: Immunotherapy combination in the NHS for Endometrial Cancer

In the United Kingdom, around 9,700 women are diagnosed with endometrial (womb) cancer annually, making it the most common gynaecological cancer. Unfortunately, for those facing the disease at its most advanced stage, the odds are stark, with just 15% of them expected to survive five years following diagnosis. If you or your loved ones have received a diagnosis of endometrial cancer, to effectively treat and cure this condition, your options have been limited so far. However, for the first time, immunotherapy has been incorporated to treat this condition. NICE has recommended an immunotherapy combination which can offer endometrial cancer patients a longer and better quality of life.

This new approach can substantially improve the effectiveness of the therapy outcomes compared to the current standard therapy for endometrial cancer, i.e., the chemotherapy combination of carboplatin and paclitaxel, which, even though it is effective for some and can slow down the cancer's progress, often causes cancer recurrence, thereby offering an uncertain outcome.

So what is this new treatment?

This combination therapy newly added pembrolizumab (made by Merck Sharp & Dohme), an immunotherapy drug, to the already used standard chemotherapy drugs (carboplatin and paclitaxel) for treating endometrial cancer. So what does this immunotherapy drug do? It boosts your immune system, helping it recognise and fight cancer cells more effectively. These chemotherapy and immunotherapy drugs, when combined, offer a powerful double approach where chemotherapy drugs directly kill the cancer cells, whereas the immunotherapy drug helps your immune system continue to fight even after chemotherapy is over.

The clinical trial named KEYNOTE-868 was conducted to see whether combining the standard chemotherapy with pembrolizumab prolongs life expectancy and keeps cancer under control. Patients were randomised to two groups, where one group received pembrolizumab alongside carboplatin and paclitaxel, followed by pembrolizumab on its own, whereas the other group received chemotherapy alone. According to the trial's results, patients in the group who had pembrolizumab with chemotherapy had significantly greater outcomes than those who only had chemotherapy, including a longer time for their disease to return or worsen and a higher chance of survival at follow-up (reducing the risk of death by 26%). This advantage was observed in the whole trial population, but it was more pronounced in those with mismatch repair deficient (dMMR) cancer (where cancer cells have trouble repairing their DNA), which frequently responds better to immunotherapy.

On examining the trial evidence, patient responses, and the possible costs and advantages for the NHS by the NICE appraisal committee, they found that the trial evidence was significant and directly relevant to NHS patients and that the treatment is cost-effective.

Overall, people with advanced or recurrent endometrial cancer now have a novel, efficient, and personalised alternative of pembrolizumab in combination with carboplatin and paclitaxel. It offers patients and their loved ones more time, hope, and a better chance against a difficult illness by having the ability to prolong life, slow the progression of cancer, and enhance quality of life.

Sources

1. Pembrolizumab with carboplatin and paclitaxel for untreated advanced or recurrent endometrial cancer [ID6381] 025 [cited 2025 Aug 14]. Available from: https://www.nice.org.uk/guidance/gid-ta11461/documents/674

   
   

2. NICE approves first immunotherapy combination for endometrial cancer. NICE website: The National Institute for Health and Care Excellence [Internet]. 2025 [cited 2025 Aug 14]. Available from: https://www.nice.org.uk/news/articles/nice-approves-first-immunotherapy-combination-for-endometrial-cancer.

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