Evaluation of the combination lenvatinib and pembrolizumab in endometrial cancer; a real world multi-institutional review of practice patterns, efficacy and tolerability

Bradley R. Corr, University of Colorado Health Cancer Center, Aurora, CO
Samantha M. Thomas, Duke Cancer Institute, Durham, NC
Paulina J. Haight, The Ohio State University Wexner Medical Center, Columbus, OH
Elizabeth Stock, Washington University School of Medicine, St. Louis, MO
Jessica Floyd, University of Colorado Health Cancer Center, Aurora, CO
Lindsay E. Borden, Stephenson Oklahoma Cancer Center, Oklahoma City, OK
Irina Tunnage, New York University Langone Health, New York, NY
Angeles Alvarez Secord, Duke School of Medicine, Durham, NC
Rebecca Arend, University of Alabama at Birmingham, Birmingham, AL
Amanda L. Jackson, University of Cincinnati College of Medicine, Cincinnati, OH
Jason D. Wright, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
Gottfried Konecny, University of California, Los Angeles, Santa Monica, CA
Tara Castellano, LSU Health Sciences Center - New OrleansFollow
Emily Ko, Hospital of the University of Pennsylvania, Philadelphia, PA
Sarah Podwika, University of Virginia Health System, Charlottesville, VA
Floor Backes, The Ohio State University Comprehensive Cancer Center, Columbus, OH
Daniel Spinosa, University of Colorado Health Cancer Center, Aurora, CO
Margaret Mullen, Washington University School of Medicine, St. Louis, MO
Christina Washington, Stephenson Oklahoma Cancer Center, Oklahoma City, OK
Bhavana Pothuri, New York University Langone Health, New York, NY
Carson Smitherman, Duke School of Medicine, Durham, NC
Alfonsus Adrian Hadikusumo Harsono, University of Alabama at Birmingham, Birmingham, AL
Hanaa Khadraoui, University of Cincinnati, Cincinnati, OH
Yukio Suzuki, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
Ritu Salani, University of California, Los Angeles, Santa Monica, CA
Kristina Powell, Hospital of the University of Pennsylvania, Philadelphia, PA
Shalini Subbarao, University of Virginia, Charlottesville, VA
Stephanie Gaillard, Johns Hopkins University School of Medicine, Baltimore, MD

Document Type

Article

Publication Date

8-14-2025

Publication Title

Gynecologic Oncology

Abstract

Objective: KEYNOTE-775 defined lenvatinib/pembrolizumab as the new standard-of-care for patients with proficient mismatch repair (pMMR) recurrent EC. However, the regimen required dose reductions in 66.5 % of participants and the generalizability of these results was uncertain. We conducted an observational study to determine the prescribing patterns, outcomes and side effects in a real-world setting. Methods: A national multidisciplinary consortium was utilized to study treatment patterns of patients with advanced/recurrent EC treated with lenvatinib/pembrolizumab from 2019 through 2022. Treatment decisions were based on the physician's recommendation. Results: 188 patients across 14 institutions were included. Histologic subtypes were 33 % endometrioid, 41 % serous, 9.6 % mixed, 10.1 % carcinosarcoma, and 2.1 % clear cell. 85.6 % were pMMR and 5.3 % were dMMR. Lenvatinib starting dose was 20 mg in 19.7 %, 18 mg in 14.9 %, 14 mg in 47.3 %, and 10 mg in 18.1 %. Median dose intensity of lenvatinib was 14 mg. Pembrolizumab dosing was 200 mg Q3W in 94.1 %. Grade ≥ 3 adverse events (AE) rates related to lenvatinib were similar across starting doses: 20 mg (13.5 %), 18 mg (17.9 %), 14 mg (7.9 %), 10 mg (17.6 %) (p = 0.31). Response rates in relation to lenvatinib starting dose were 20 mg (27 %), 18 mg (35.7 %), 14 mg (39.3 %), 10 mg (44.1 %) (p = 0.50). In relation to lenvatinib starting dose, PFS, OS and duration of therapy were not statistically different. Response rates (p = 0.24), PFS (p = 0.66) & OS (p = 0.22) were similar in White and Black patients. Conclusions: In a real-world analysis, the predominant starting dose was 14 mg lenvatinib and 200 mg pembrolizumab. Starting at varying doses does not appear to compromise response rates or survival and no new severe adverse events emerged.

First Page

69

Last Page

75

PubMed ID

40816031

Volume

201

Link to Full Text

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