{"doi":"10.1007/s13691-025-00752-3","title":"Immune checkpoint inhibitor restores daily function in patient with microsatellite instability (MSI)-high advanced endometrial cancer and poor performance status","abstract":"<jats:title>Abstract</jats:title>\n          <jats:p>The immune checkpoint system suppresses T-cell activity. Unlike cytotoxic anticancer drugs that directly kill cells, immune checkpoint inhibitors (ICIs) are generally safer by stimulating tumor immunity. However, most clinical trials require patients to have a better performance status (PS), leaving limited evidence for those with poorer PS. In practice, patients may be classified with poor PS due to tumor-induced pain and motor dysfunction, even if major organs remain functional. Real-world data on non-small cell lung cancer has shown no safety difference between patients with PS 3/4 and those with lower PS. Approximately 20–30% of endometrial cancer cases show microsatellite instability-high (MSI-high), the highest among common malignancies. A 46-year-old patient with advanced, recurrent endometrial cancer resistant to standard chemotherapy, and PS of 4 from severe pelvic pain, was diagnosed with MSI-high. Pembrolizumab was initiated and continued for 19 courses, after which lesions had disappeared or calcified, leading to drug discontinuation. Now, 4 and a half years post-treatment, she has regained independent mobility and returned to work, and her PS has improved to approximately 1. Side effects included Grade 2 or lower thyroiditis, hypothyroidism, and hypoadrenalism, manageable with hormone replacement therapy and temporary pembrolizumab suspension. This case underscores the need to test for MSI-high/mismatch repair deficiency in endometrial cancer and to consider ICI therapy in patients with poor PS but no major organ dysfunction. In such cases, ICI can rapidly improve overall condition, a phenomenon known as a Lazarus-type response, as seen in other cancers such as non-small cell lung cancer.</jats:p>","journal":"International Cancer Conference Journal","year":2025,"id":648550,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1072881,"name":"Taichi Yoshida","orcid":"0000-0002-6912-3223","position":1,"is_corresponding":false},{"id":1690229,"name":"Yuya Takahashi","orcid":null,"position":2,"is_corresponding":false},{"id":1375674,"name":"Koji Fukuda","orcid":"0000-0001-8544-6244","position":3,"is_corresponding":false},{"id":1690233,"name":"Kazuhiro Shimazu","orcid":null,"position":4,"is_corresponding":false},{"id":700199,"name":"Daiki Taguchi","orcid":"0000-0003-3426-8251","position":5,"is_corresponding":false},{"id":1690237,"name":"Hanae Shinozaki","orcid":null,"position":6,"is_corresponding":false},{"id":1690240,"name":"Naoaki Kodama","orcid":null,"position":7,"is_corresponding":false},{"id":1690242,"name":"Shunsuke Kato","orcid":null,"position":8,"is_corresponding":false},{"id":1003629,"name":"Hironori Waki","orcid":"0000-0002-5302-9793","position":9,"is_corresponding":false},{"id":1612941,"name":"Hiroshi Nanjo","orcid":null,"position":10,"is_corresponding":false},{"id":700205,"name":"Hiroyuki Shibata","orcid":"0000-0003-3581-3506","position":11,"is_corresponding":false},{"id":1690228,"name":"Ayaka Matsui","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Immune checkpoint inhibitor restores daily function in patient with microsatellite instability (MSI)-high advanced endometrial cancer and poor performance status","abstract":"<jats:title>Abstract</jats:title>\n          <jats:p>The immune checkpoint system suppresses T-cell activity. Unlike cytotoxic anticancer drugs that directly kill cells, immune checkpoint inhibitors (ICIs) are generally safer by stimulating tumor immunity. However, most clinical trials require patients to have a better performance status (PS), leaving limited evidence for those with poorer PS. In practice, patients may be classified with poor PS due to tumor-induced pain and motor dysfunction, even if major organs remain functional. Real-world data on non-small cell lung cancer has shown no safety difference between patients with PS 3/4 and those with lower PS. Approximately 20–30% of endometrial cancer cases show microsatellite instability-high (MSI-high), the highest among common malignancies. A 46-year-old patient with advanced, recurrent endometrial cancer resistant to standard chemotherapy, and PS of 4 from severe pelvic pain, was diagnosed with MSI-high. Pembrolizumab was initiated and continued for 19 courses, after which lesions had disappeared or calcified, leading to drug discontinuation. Now, 4 and a half years post-treatment, she has regained independent mobility and returned to work, and her PS has improved to approximately 1. Side effects included Grade 2 or lower thyroiditis, hypothyroidism, and hypoadrenalism, manageable with hormone replacement therapy and temporary pembrolizumab suspension. This case underscores the need to test for MSI-high/mismatch repair deficiency in endometrial cancer and to consider ICI therapy in patients with poor PS but no major organ dysfunction. In such cases, ICI can rapidly improve overall condition, a phenomenon known as a Lazarus-type response, as seen in other cancers such as non-small cell lung cancer.</jats:p>","is_dataset_classified":null,"base_score":0.0,"endowment":0.0,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"40160883","pmcid":"PMC11950546","openalex_id":"https://openalex.org/W4407450513","authors":[],"funders":[],"total_grants":0,"fwci":0.0,"citation_percentile":0.02427035,"influential_citations":0,"citation_trend":[],"oa_status":"hybrid","license":"cc-by","oa_locations":[{"url":"https://link.springer.com/content/pdf/10.1007/s13691-025-00752-3.pdf","host_type":"conference"},{"url":"https://link.springer.com/content/pdf/10.1007/s13691-025-00752-3.pdf","host_type":"publisher"},{"url":"https://link.springer.com/article/10.1007/s13691-025-00752-3/fulltext.html","host_type":"publisher"},{"url":"https://doi.org/10.1007/s13691-025-00752-3","host_type":"conference"},{"url":"https://pubmed.ncbi.nlm.nih.gov/40160883","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/11950546","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC11950546","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC11950546?pdf=render","host_type":"Europe_PMC"}],"fields_of_study":["Cancer Immunotherapy and Biomarkers","Endometrial and Cervical Cancer Treatments","Multiple and Secondary Primary Cancers"],"mesh_terms":[],"keywords":["Endometrial cancer","Microsatellite instability","Immune checkpoint","Immune system","Medicine","Internal medicine","Oncology","Function (biology)","Cancer","Cancer research","Biology","Microsatellite","Immunotherapy","Gene","Immunology","Genetics","Performance Status","Immune Checkpoint Inhibitor","Microsatellite Instability-high","Pembrolizumab"],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-10T02:43:58.718690Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}