Treatment Of Advanced Endometrial Cancer: A Systematic Review Of Efficacy And Safety In Clinical Trials, Molecular-Targeted Therapies And Immunotherapy.

Introduction: Endometrial cancer is the most common gynecological malignancy in developed countries. Although it has a good prognosis in the early stages, the management of advanced endometrial cancer remains a therapeutic challenge. The emergence of molecular target therapies and immunotherapies represents a promising advance in the individualized treatment of this condition. Objective: To evaluate, through a systematic review, the efficacy and safety of molecular-targeted therapies and immunotherapies used in patients with advanced endometrial cancer, based on data from recent clinical trials. Methods: The search was conducted in PubMed, Scopus, Embase, Web of Science and Cochrane Library, covering published studies. Clinical trials addressing systemic targeted or immunologic therapies for advanced endometrial cancer were included. Data were extracted and analyzed descriptively, with an emphasis on objective response rates (ORR), progression-free survival (PFS), overall survival (OS) and adverse events. Results: 12 clinical trials were included. mTOR inhibitors and antiangiogenic drugs showed ORR between 10% and 20%, with better performance when combined with hormone therapy. Immunotherapy with pembrolizumab was highly effective in patients with microsatellite instability (MSI-H), with ORR above 45%. The combination of pembrolizumab + lenvatinib showed significant benefit even in MSS tumors, with ORR between 35% and 39% and prolongation of OS. Conclusion: Molecular-targeted therapies and immunotherapies are reshaping the treatment of advanced endometrial cancer. Molecular biomarker-based selection and strategic combination of agents have the potential to significantly improve clinical outcomes, indicating the need for therapeutic personalization as a new paradigm in oncological management.