Immunotherapy in Gynecologic Cancers: Current Evidence, Biomarker-Driven Practice, and Future Directions

Abstract

Simple Summary Immunotherapy has changed the treatment of several gynecologic cancers, but its benefit varies greatly between tumor types and clinical settings. The clearest benefits are seen when treatment is matched to tumor biology, such as mismatch repair deficiency in endometrial cancer or PD-L1 expression in selected cervical and ovarian cancer settings. In ovarian cancer, most unselected immunotherapy strategies have been unsuccessful, although a recent phase III study identified a treatment option for a selected platinum-resistant population with only a modest absolute gain in progression-free survival. Patients with rare tumors, including gestational trophoblastic neoplasia, may also benefit in selected circumstances. This review focuses on how tumor biology, biomarkers, treatment setting, toxicity, and prior therapy should guide the appropriate use and future development of immunotherapy.