Immune evasion in endometrial cancer: Unraveling the latest mechanisms and future directions
Endometrial cancer (EC) is a common gynecological malignancy, and its incidence has been increasing in recent years. The deepening understanding of the interaction between the tumor microenvironment and immune system has drawn increasing research attention to immunotherapy. In 2013, the Cancer Genome Atlas project performed molecular classification of EC, which revealed the genomic alterations of different molecular subtypes. Especially the discovery of microsatellite instability high /mismatch repair deficiency subtypes has made the application of immunotherapy in EC possible. However, immune evasion allows EC to survive after encountering the host immune system. Recently, researchers have continuously identified new mechanisms of immune evasion, such as the alteration of MHC-I molecules, the abnormal expression of immune checkpoint molecules, and the role of immunosuppressive cells. In this review, we will discuss the progress in understanding the basis of immune evasion in EC and summarize various combinations of immune checkpoint inhibitors that have been developed or are being studied. In the future, with a deeper understanding of the immune evasion mechanism, immunotherapy is expected to improve outcomes in patients with EC.