Nearly alleviated!Immunotherapy brings new treatment options for patients with endometrial cancer

*For medical professionals for reading reference

Immunotherapy will become the "new pillar" of advanced uterine endometrial cancer treatment?

Endometrial cancer is an epithelial malignant tumor that occurs in the endometrium, also known as uterine carcinoma. It is one of the three common malignant tumors of women's reproductive tracts. Most of them occur in women's menstrual periods and postmenopausal women [1]. According to the "2015 Analysis of the Popularity of China's malignant tumor in 2015" released by the National Cancer Center in 2019, the incidence of endometrial cancer in my country is 10.28/100,000, which is the second common gynecological malignant tumor in my country [2].

The main treatment methods of endometrial cancer are surgery and chemotherapy. In recent years, with the development of clinical studies, immunotherapy has shown a good curative effect in the treatment of endometrial cancer [3]. At present, research has been suggested that the PD-1 inhibitors' second and above treatment metastatic endometrium cancer has a good curative effect [4] and was recommended by domestic and foreign guidelines [5, 6].

In this issue of "Sound of the Examples", Dr. Wu Tao, the First People's Hospital of Changde City, shared a case of patients with lateral endometrium cancer with multiple lymph nodes metastasis. Patients received surgical treatment and postoperative chemotherapy (PR ) The good effect, after receiving the maintenance treatment of Envolito, the patient's condition was further relieved, and even close to the complete relief (CR). Let's take a look at the treatment process of the patient.

Retrospective

General information

Patient's female, 54 years old, came to the hospital in March 2021 due to "irregular vaginal bleeding in the vagina" in March 2021. He had had the left tubal resection of the left side of the palace. The age is unknown).

Physical examination

The vulva develops normally, the vagina is smooth, and a little dark brown blood stains are seen inside. The left neck can be 扪 and 2 cm × 2 cm large lymph nodes, hard, no tenderness, and the border is not clear.

Auxiliary inspection

Human chorionic gonadotropin (β-HCG): 6.85 mIU/ml, follicle (FSH): 72.68 miU/ml, estradiol (E2): 85.21 PMOL/L, testosterone: 0.83 nmol/L, sugar antigen 12 -5 (CA12-5): 485.40 U/ml.

2021-03-03 Pelvic color ultrasound

The weak echo group in the uterine cavity, the substantial echo of the uterus is slightly stronger, the uterine cavity effusion, and the low echo area of ​​the right attachment area, considering it as a limited thickening tube.

2021-03-06 Pelvic enhancement MRI

Anomalial signal shadow in the uterine cavity is considered as a blood clot, which does not rule out the possibility of endometrial disease and is accompanied by cervical gland cysts.

2021-03-08 pathological test

(Gulfic+cervical scraping) combined with immunohistochemistry, in line with transparent cell carcinoma. Immunization group: Vimentin (stove+), CEA (-), ER (+), PR (small stove+), P16 (stove+), P53 (+, about 40%), WT-(-), Ki67 ( +, About 60%), IMP3 (stove+), napsina (small stove+).

2021-03-12 Lung+full abdomen enhancement CT

The density of the uterine cavity is uneven, and the enhancement is not uniformly enhanced. After the peritoneal, the multiple nodules are considered to be metastasized, and the liver cyst. The lymphadenopathy of the upper clavicle of the left neck was enlarged, and there was no obvious abnormality.

Figure 1 Patients on March 12, 2021, lung+full abdomen enhancement CT image

2021-03-18 PET-CT

After the cervical cervical cervical cure, no abnormal metabolism increases in the local area; the left neck, abdominal cavity, abdominal membrane, and bilateral iliac blood vessels are seen with multiple increasing lymph nodes. The metabolism is significantly increased. , See the filling defect of the zoscao; the subtraction of the lower lung lobe obliquely, the sub -nodules of the pleural, the metabolism is slightly increased, and it is considered as the possibility of inflammatory nodules; the two upper neck lymph nodes, the metabolism is slightly increased, considering the lymph node reaction hyperplasia; Small cysts in the liver.

Figure 2 Patients PET-CT image on March 18, 2021

2021-3-18

Multi -disciplinary diagnosis and treatment (MDT) is recommended to improve colonoscopy, gastroscopy, and left rear neck lymph node puncture biopsy.

Electronic gastroscopy:

Non -atrophic gastritis (superficial gastritis) is accompanied by erosive esophagitis.

Electronic colonoscopy:

Poetry polyps of the large intestine, lowering colonitis; pathological results show (lift colorectal) conform to the velvet glandular glandular tumor.

Left rear neck lymph node puncture biopsy:

Lymph node metastatic adenocarcinoma, combined with the result of immune groupization, is in line with endometrial sources.

Immunohistochemistry:

CK20 (-), CK7 (+), Villin (Stove+), Vimentin (Stove+), ER (+, 60%, Strong), PR (-), P16 (Stove+), P53 (+), Napsina (Napsina ( -), Gata3 (-), WT-1 (scattered+), Ki67 (+, 50%).

diagnosis

IVB endometrium transparent cell carcinoma (FIGO 2018), with cervical lymph node metastasis.

PR is enough? Envolimu helps patients to approach CR

Dr. Wu Tao pointed out that according to the "National Comprehensive Cancer Network (NCCN) Uterine Tumor Clinical Practice Guide 2022 V1" (hereinafter referred to as the "NCCN Guide"), considering systemic treatment, local radiotherapy, and puzzle surgery to treat patients for patients for treatment [6]. After MDT, on March 26, 2021, for the patient, "opening the abdominal uterine resection+left attachment removal+right ovarian resection+pelvic enlarged lymph nodes+bilateral ureteral relief+pelvic adhesion and decomposition+intestinal adhesion Lifting. Postoperative pathological test tips:

(Uterus) The endometrium of a small amount of proliferation during the residual period, the chopper is atypical hyperplasia, and no obvious cancer tissue residues were seen at the original lesions; no cancer tissue was involved in the cervix, left tubal, bilateral ovarian and bilateral palace.

Uterine adenomia, atypical hyperplasia of stove gland epidermal.

(Cervical) Chronic cervicitis, scales epithelium hyperplasia and transformation.

(Left) chronic fallopian tube, (bilateral) ovarian white body formation.

Sailoring lymph nodes can be metastasized by cancer (4/9 on the left pelvic cavity, 1/2 on the right pelvic cavity).

Immunization group: -7, ER (stove+), PR (-), Vimentin (-), CA125 (+), P16 (+), P53 (60%+), Ki67 (50%+), CEA (- ），CK7（+），CDX-2（-），NapsinA（-），P504s（-），MLH1（+），MSH2（-），MSH6（-），PMS2（+）；-38，P53（3 %+), Ki67 (3%+), napsina (-), PAX-2 (weak+).

According to the NCCN guide, for patients with endometrial cancer, systemic treatment can be given after surgery and may consider joint local radiotherapy as appropriate. Therefore, after the patient surgery, the 3 -cycle TP scheme chemotherapy is given. After the review enhances the CT display, part of the lymph nodes in the neck and the back of the peritoneum increases, and the lymph nodes beside the left iliac vascular are narrowed before. Subsequently, the patient's (next to the abdominal aorta+pelvic cavity) lymphatic radiotherapy area, and continued to give the 3 -cycle TP scheme chemotherapy at the same time, and obtained the efficacy of PR.

Figure 3 Patients with CT image on March 12, July 7, and November 25, 2021

Dr. Wu Tao said that combined with the patient's postoperative pathological test results, it can be found that the patient's microbriet is MSI-H type. For such patients, immunotherapy can be considered in the future. Therefore, from December 5, 2021, the patient Evoli Morning Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -treatment show was reviewed on March 11, 2022. Close to the curative effect of CR, CA12-5 also returned to normal horizontal range.

Figure 4 Patients with CT image on March 11, 2022

Expert Reviews

Uterine endometrial cancer is the second highest gynecological tumor in my country, and with the increase of the average life expectancy of the population and the change of living habits, the incidence of endometrial cancer has continued to rise and younger for nearly 20 years [1] Essence The treatment of endometrial cancer is based on surgical therapy. With increasing evidence, immunotherapy can bring survival benefits to some patients with MSI-H/DMMR types, and gradually become endometrial endometrium The "new pillar" in the field of cancer treatment.

KN035-CN-006 Studies have shown that Envoli Single Anti-Single Drug (150mg QW) was used for 103 cases of MSI-H/DMMR patients with second-line treatment. The objective relief rate (ORR) can reach 44.7%, and it has good Security [7]. Clinically, patients with endometrial endometrial transparent cell carcinoma in the stage IVB usually have poor prognosis. This patient obtains the efficacy of PR after receiving surgical treatment and postoperative chemotherapy. The efficacy shows the potential of Envolimab to such patients.

Expert Introduction

Professor Wu Tao

Graduate mentor of the Chief Physician of the Department of Cancer Department of the First People's Hospital of Changde City

Member of the Breast Tumor Professional Committee of the China Junior Health Care Foundation

Deputy Chairman of the Hunan International Medical Exchange Promotion Association of the Breast Cancer Professional Committee

Deputy Leader of the Women's Tumor Treatment Group of the Hunan Medical Association Radiotherapy Professional Committee

Executive Member of the MDT Professional Committee of the Hunan International Medical Exchange Promotion Association

Youth Member of the Radiotherapy Professional Committee of Hunan Anti -Cancer Association

Youth Member of the Internal Science Committee of Hunan Medical Association

Member of the World Chinese Medical Physician Association Radible and therapy Professional Executive Committee

Member of the Hunan Anti -Cancer Association Precision Radiotherapy Committee

references:

[1] "Guidelines for the diagnosis and treatment of endometrial cancer (2022 edition)"

[2] Zheng Rongshou, Sun Kexin, Zhang Siwei, et al. Analysis of the epidemic of malignant tumors in 2015 [J]. Chinese Oncology Magazine, 2019,41 (01): 19-28.

[3] The Chinese Anti-Cancer Association Gynecology and Tumor Professional Committee. The Guide to the Diagnosis and Treatment of Endometrial Cancer (2021) [J]. China Cancer Magazine, 2021,31 (06): 501-512.

J]. Lancet Oncol. 2020, 21 (10): 1353-1365. [5] "China Clinical Oncology Society (CSCO) immune examination point inhibitor clinical application guide 2021"

[6] "National Comprehensive Cancer Network (NCCN) uterine tumor clinical practice guide 2022 V1"

[7] Shen Lin, Li Jian, Deng Yanhong, waiting for. EnvaFolimab (KN035) single-medicine single-arm, multi-centered phase II research data update [abstract]. 2021CSCO: 10142.

*This article is only used to provide scientific information to medical people, and does not represent the viewpoint of this platform

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