Female Reproductive Cancer: Is Immunotherapy a Treatment Option for You?

This article is for women who have gynecologic (female reproductive) cancer and their caregivers, or anyone who wants to learn more about gynecologic cancer. The goal of this patient education activity is help patients and their caregivers engage in shared decision-making with their doctor about immunotherapy as treatment for gynecologic cancer.

You will learn about:

• What gynecologic cancer is

• Making a treatment plan with your doctor

• Available treatment options, including immunotherapy

• Possible side effects from immunotherapy

• Questions to ask your doctor

All medicines listed in this activity may not be approved by the US Food and Drug Administration (FDA) for gynecologic (female reproductive) cancer but are recommended by the National Comprehensive Cancer Network (NCCN).

Before you start, please answer this question. At the end of the program, you'll have a chance to answer the question again and then see the correct answer.

Cancer that affects the female reproductive system -- ovaries, endometrium, or cervix -- is called gynecologic cancer.

These cancers are named for the place in the body where they start. Ovarian cancer starts in the cells in the outer layer of tissue around the ovaries; endometrial cancer in cells in the endometrium, the inner lining of the uterus (womb); and cervical cancer in the cells lining the cervix, the lower part of the uterus.

Sometimes cancer cells can break away from where they first started and spread (metastasize) to other parts of the body. If this happens it's called metastatic cancer.

Multiple treatments are available for gynecologic cancers. No one treatment is best for everyone, so you and your doctor will make a treatment plan together that fits your individual needs.

Factors your doctor considers when recommending treatment include:

• Location and stage of your cancer, and if it has spread

• Your age, overall health, and other conditions you may have

• Your genetics (traits passed on from your parents) and family medical history

• Your needs and personal preferences

Your treatment may change over time based on how your body responds and your preferences.

There are several treatment options for gynecologic cancer that your doctor may recommend. These can include surgery, radiation therapy, chemotherapy (or "chemo"), medicines, and joining a clinical trial.

With surgery, the 2 main goals will be to remove all, or as much, of the cancer as possible, and to see if the cancer has spread. Chemotherapy may also be recommended, before or after surgery. Chemotherapy stops cancer cells from completing their life cycle so they can't increase in number and kills fast-growing cells, such as cancer cells.

Medicines that may be recommended, depending on your type of gynecologic cancer, include targeted therapy, hormone therapy, or immunotherapy.

Immunotherapy is treatment that helps your immune system -- your body's natural defense system -- fight a disease, such as cancer.

Your immune system is made up of different organs, cells, and proteins that work to help protect you. Immunotherapy increases your immune system's activity to help improve your body's ability to find and kill cancer cells.

Immunotherapy works differently against cancer than other treatments, such as chemotherapy. Chemotherapy is used to kill fast-growing cells throughout the body, including cancer cells. Because of this, it can sometimes also kill healthy cells by accident.

Certain immunotherapy may be used as treatment for gynecologic cancer, including a type called checkpoint inhibitors. Some of these medicines work by inhibiting PD-1, a protein that's on your T cells (a certain type of immune cell). This helps your T cells do their job better and attack cancer cells.

PD-1 inhibitors for gynecologic cancer are given by IV (intravenously) into a vein. These include pembrolizumab (Keytruda®) and nivolumab (Opdivo®).  

All medicines listed in this activity may not be approved by the FDA for gynecologic cancer, but are recommended by the National Comprehensive Cancer Network (NCCN).

If your doctor recommends immunotherapy, they may take a sample of your blood or tissue to test for biomarkers. A biomarker can be used to see how well your body may respond to a treatment.

Immunotherapy medicines your doctor may recommend include:

• Pembrolizumab for ovarian cancer

• Pembrolizumab in combination with another medicine; or pembrolizumab or nivolumab alone if you have certain biomarkers for endometrial cancer

• Pembrolizumab if you have certain biomarkers for cervical cancer

Side effects that may happen with immunotherapy include:

• Diarrhea, nausea, vomiting, and belly pain

• Fatigue (tiredness)

• Skin rashes and itchiness

• Headaches, dizziness

• Kidney problems, including infections

• Thyroid or liver problems

• Fever, chills, or an allergic reaction when given as an IV infusion

• Inflammation of the lungs (pneumonitis), cough, shortness of breath, or chest pain

• Changes in hormone levels

All immunotherapy can have side effects, but not all side effects are listed here. Ask your doctor for a complete list and when you should call your doctor or go to the emergency room because of side effects.

Before you start treatment, ask your doctor about any side effects that may happen. Be sure to tell them about any you have during treatment and how they affect your daily life. Some side effects can go away on their own over time, but others may last longer. Together, you and your doctor can discuss ways to manage side effects. Your doctor may recommend changing treatment or adding a medicine before, during, or after treatment to help.

Tracking and recording your side effects in a journal or diary can be helpful for when you talk to your doctor.

Questions you can ask your doctor about gynecologic cancer and treatment, including immunotherapy, can include:

• What treatments are available for the type of gynecologic cancer I have?

• What are the possible side effects of treatment, and what's the best way to manage them?

• How will I know if treatment is working?

• Is there a clinical trial that I might be eligible for?

• How can I make sure I have the best quality of life possible?

• Are there any lifestyle changes I should make?

• What should I do if I feel stressed or depressed?

Congratulations!

You have successfully completed the program: Female Reproductive Cancer: Is Immunotherapy a Treatment Option for You?

View Additional Materials

View Additional Materials on this topic that you may find useful:

Patient Handout

Cervical Cancer Factsheet

How Is Cervical Cancer Diagnosed and Treated?

Endometrial (Uterine) Cancer

How Is Endometrial (Uterine) Cancer Treated?

Ovarian Cancer

How Is Ovarian Cancer Treated?