The efficacy and safety of pembrolizumab and dostarlimab in advanced endometrial carcinoma: a systematic review

Background Endometrial cancer constitutes a substantial proportion of gynaecological malignancies globally, representing 83% of uterine corpus cancers. With an annual incidence of 60,000 new cases and 11,000 deaths, it is a significant health concern. Emerging molecular therapies, including pembrolizumab and dostarlimab, show promise in advanced cases. This systematic review assesses the efficacy and safety of pembrolizumab and dostarlimab in advanced endometrial cancer. Methods The study adhered to a PROSPERO-registered protocol (CRD42023471455) detailing research questions, objectives, and inclusion/exclusion criteria. A thorough search across multiple databases until October 2023 utilised specific keywords. Inclusion criteria encompassed RCTs and observational studies focusing on female patients with advanced endometrial carcinoma, evaluating pembrolizumab or dostarlimab efficacy and safety. Independent reviewers performed data extraction and quality assessment. Results The search yielded 16 studies involving 5168 participants, with interventions including pembrolizumab and dostarlimab. The risk of bias varied across studies. Dostarlimab demonstrated significantly improved progression-free and overall survival. Pembrolizumab exhibited a moderate objective response rate. Adverse events, including treatment-related deaths, dose reductions, and discontinuations, were noted for both treatments. Conclusion Dostarlimab presents promising results with improved survival outcomes, while pembrolizumab exhibits a moderate response rate. The complex nature of treatment outcomes shows the need for more evaluations. Future studies should focus on biomarker identification, validation, and factors contributing to conflicting results. Comparative studies and exploration of combination therapies could enhance understanding and treatment strategies.