Immunotherapy in Gynecologic Oncology: A Comprehensive Review

Abstract

Gynecologic oncology encompasses a spectrum of malignancies affecting the female reproductive tract, including cervical, ovarian, endometrial, vulvar, and vaginal cancers. These diseases pose significant global health challenges, with over 1.3 million new cases and 670,000 deaths annually. Traditional treatments like surgery, chemotherapy, and radiation have limitations, particularly in advanced or recurrent settings. Immunotherapy has emerged as a transformative paradigm, harnessing the immune system to target cancer cells. This review synthesizes recent advances in immunotherapy modalities—such as immune checkpoint inhibitors (ICIs), chimeric antigen receptor T-cell (CAR-T) therapies, and cancer vaccines—focusing on their application in gynecologic cancers. Key findings include objective response rates (ORR) of 42.3% for dostarlimab in mismatch repair-deficient (dMMR) endometrial cancer from the GARNET trial [34], 12.2% for pembrolizumab in PD-L1-positive recurrent cervical cancer from KEYNOTE-158 [10], and a pooled ORR of 21% for PD-1/PD-L1 inhibitors in recurrent ovarian cancer, with combinations enhancing progression-free survival (PFS) by up to 32% (HR 0.68) as seen in CALLA and IMagyn050 [0,29]. We discuss clinical trial outcomes, biomarkers for patient selection, combination strategies, challenges, and future directions. Drawing from over 30 peer-reviewed sources published between 2020 and 2025, this analysis underscores immunotherapy's potential to improve survival while highlighting ongoing hurdles like resistance and toxicity. Tables summarizing key trials, efficacy metrics, and biomarkers enhance the review's utility for clinicians and researchers.