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Review
. 2022 Aug 22:12:975201.
doi: 10.3389/fonc.2022.975201. eCollection 2022.

Importance of the endometrial immune environment in endometrial cancer and associated therapies

Hannah van der Woude  1 , Kathryn Elizabeth Hally  2 , Margaret Jane Currie  3 , Olivier Gasser  4 , Claire Elizabeth Henry  1
Affiliations
Review

Importance of the endometrial immune environment in endometrial cancer and associated therapies

Hannah van der Woude et al. Front Oncol. .

Abstract

Endometrial cancer is rising in prevalence. The standard treatment modality of hysterectomy is becoming increasingly inadequate due primarily to the direct link between endometrial cancer and high BMI which increases surgical risks. This is an immunogenic cancer, with unique molecular subtypes associated with differential immune infiltration. Despite the immunogenicity of endometrial cancer, there is limited pre-clinical and clinical evidence of the function of immune cells in both the normal and cancerous endometrium. Immune checkpoint inhibitors for endometrial cancer are the most well studied type of immune therapy but these are not currently used as standard-of-care and importantly, they represent only one method of immune manipulation. There is limited evidence regarding the use of other immunotherapies as surgical adjuvants or alternatives. Levonorgestrel-loaded intra-uterine systems can also be effective for early-stage disease, but with varying success. There is currently no known reason as to what predisposes some patients to respond while others do not. As hormones can directly influence immune cell function, it is worth investigating the immune compartment in this context. This review assesses the immunological components of the endometrium and describes how the immune microenvironment changes with hormones, obesity, and in progression to malignancy. It also describes the importance of investigating novel pathways for immunotherapy.

Keywords: adiposity; endometrial cancer; immunotherapy; levonorgestrel; microenvironment.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Fluctuations of estrogen and progesterone throughout normal menstrual cycle and corresponding immune activity.
Figure 2
Figure 2
Distribution of immune cell populations in normal endometrial tissue.
See this image and copyright information in PMC

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