Molecular classification and immunotherapy in fertility-sparing treatment for endometrial cancer: opportunities and challenges
Endometrial cancer (EC) is one of the most common malignant tumors in women, and its incidence is rising continuously worldwide. According to recent global cancer statistics, there were about 417,000 new cases and 97,000 deaths from EC in 2020(1). The standard treatment for EC is hysterectomy, which undoubtedly deprives some young patients of their fertility. Fertility-sparing treatment (FST) for endometrial cancer allows these women to preserve fertility before undergoing standard treatment. Traditional fertility-sparing regimens are mainly based on progestin. However, in recent years, with the application of molecular classification, some studies have found that among patients undergoing FST, women with POLE mutations (POLE-mut) often have a higher complete remission (CR) rate, while those with P53 abnormal (P53abn) or mismatch repair deficiency (dMMR) have poor prognosis. Among them, patients with dMMR endometrial cancer seem to have a higher recurrence rate after achieving complete remission through progestin treatment. Currently, fertility-sparing treatment regimens for dMMR patients are being gradually studied, and immune checkpoint inhibitors (ICIs) may play a key role in the treatment.