Immunotherapy in gynecologic malignancies

Immunotherapy has recently been added to the treatment modalities of gynecologic cancers. The most commonly used approaches utilize immune checkpoint inhibitors (ICIs) with antibodies directed against programmed cell death receptor 1 or PDL-1. The clinical efficacy of single-agent ICI in gynecologic cancers is low for cervical and ovarian cancer, but significantly higher in endometrial cancer with defects in DNA mismatch repair. Tumor with high PDL-1 expression, tumor mutational burden, and MSI status are used as predictors of response to immunotherapy. Therapeutic cancer vaccines have the potential to activate tumor-reactive T cells by presenting antigens that are specific to the patient’s tumor. Adoptive cell therapies are still under investigation but have shown promising and long-lasting anti-tumor responses in cervical cancer patients. A large number of clinical trials using a myriad of immunotherapeutic strategies is currently ongoing and will provide more insight into the clinical efficacy and biological mechanisms of the approaches. Immunotherapy has the potential to provide personalized treatments that target the specific immunological landscape of each individual tumor.