The FDA has expanded the approval of dostarlimab (Jemperli) in combination with carboplatin and paclitaxel, followed by dostarlimab maintenance monotherapy, for adult patients with primary advanced or recurrent endometrial cancer. This decision, announced on August 1, 2024, marks a significant advancement in the treatment landscape for this challenging disease, offering new hope for patients with aggressive forms of endometrial cancer.
The expanded indication is supported by findings from part 1 of the phase 3 RUBY trial (NCT03981796). The RUBY trial demonstrated a statistically significant improvement in overall survival with dostarlimab compared to placebo in the study population. This trial included patients with carcinosarcoma and those with slightly earlier disease stages, differentiating it from other trials like the NRG-GY018 trial, which used pembrolizumab (Keytruda).
Clinical Significance of the RUBY Trial
The RUBY trial's design offers specific insights into treating patients with carcinosarcoma. Matthew Powell, MD, of Washington University School of Medicine, noted that the trial has influenced treatment recommendations, with carcinosarcoma being explicitly referenced in the National Comprehensive Cancer Network (NCCN) guidelines. According to Dr. Powell, dostarlimab is now the preferred treatment option for these cases.
Impact on Endometrial Cancer Treatment
Recent treatment advancements in endometrial cancer have been limited, with few FDA approvals in the past five decades. The availability of new treatment options, particularly immunotherapy combined with chemotherapy, represents a welcome development for patients facing aggressive forms of the disease. While distinctions exist among endometrial cancer research, recent studies collectively highlight the promise of immunotherapy-chemotherapy combinations in improving outcomes for patients with endometrial cancer, especially aggressive subtypes like carcinosarcoma.
