Endometrial cancer is one of the most common gynecological malignancies, and while early-stage cases are highly treatable, recurrent or advanced EC remains challenging to manage. Immunotherapy, particularly immune checkpoint inhibitors, has revolutionized treatment approaches in oncology, and its application in EC has shown promising results. Key to immunotherapy efficacy in EC is the tumor’s mismatch repair status, with MMR-deficient tumors demonstrating a higher tumor mutational burden and increased PD-L1 expression, making them more susceptible to immune checkpoint inhibitors (ICIs) such as pembrolizumab, durvalumab, and dostarlimab. However, not all mismatch repair-deficient (MMRd) tumors respond to ICIs, particularly those with a “cold” tumor microenvironment (TME) characterized by poor immune infiltration. In contrast, some MMR-proficient tumors with a “hot” TME respond well to ICIs, underscoring the complex interplay between MMR status, tumor mutational burden (TMB), and TME. To overcome resistance in cold tumors, novel therapies, including Chimeric Antigen Receptor (CAR) T cells and tumor-infiltrating lymphocytes are being explored, offering targeted immune-based strategies to enhance treatment efficacy. This review discusses the current understanding of immunotherapy in EC, emphasizing the prognostic and therapeutic implications of MMR status, TME composition, and emerging cell-based therapies.
子宫内膜癌是最常见的妇科恶性肿瘤之一，早期病例虽具有较高的治愈率，但复发或晚期子宫内膜癌的治疗仍面临挑战。免疫疗法，尤其是免疫检查点抑制剂，已在肿瘤治疗领域引发革命性变革，其在子宫内膜癌中的应用已显示出良好前景。免疫疗法在子宫内膜癌中的疗效关键取决于肿瘤的错配修复状态：错配修复缺陷型肿瘤通常表现出更高的肿瘤突变负荷和PD-L1表达水平，使其对帕博利珠单抗、度伐利尤单抗、多塔利单抗等免疫检查点抑制剂更为敏感。然而，并非所有错配修复缺陷型肿瘤都对免疫检查点抑制剂产生应答，特别是那些具有“冷”肿瘤微环境的类型——其特征表现为免疫细胞浸润不足。相反，部分错配修复正常型肿瘤因具备“热”肿瘤微环境而对免疫检查点抑制剂反应良好，这凸显了错配修复状态、肿瘤突变负荷与肿瘤微环境之间复杂的相互作用机制。为克服冷肿瘤的耐药问题，嵌合抗原受体T细胞和肿瘤浸润淋巴细胞等新型疗法正在探索中，这些靶向免疫策略有望提升治疗效果。本综述系统探讨了当前子宫内膜癌免疫治疗的研究进展，重点阐述了错配修复状态、肿瘤微环境组成及新兴细胞疗法的预后意义与治疗价值。
肿瘤(癌症)患者之家