Current evidence and emerging approaches in immunotherapy for gynecological cancers

Gynecological cancers, such as vulvar, cervical, endometrial, and ovarian cancers, are the leading causes of morbidity and mortality among women globally. Conventional management modalities like chemotherapy, surgery, and radiotherapy have achieved limited success due to adverse side effects, resistance development, and tumor heterogeneity. Recognizing the urgent need for innovative therapeutic strategies, this narrative review explores the evolving role of immunotherapy in the management of these cancers. A comprehensive literature search was conducted using Scopus, PubMed, PubMed Central, and Google Scholar databases, focusing on peer-reviewed articles published up to 2023. The selection prioritized studies that evaluated immunotherapeutic approaches, including immune checkpoint inhibitors, cytokine therapies, cancer vaccines, and adoptive T cell therapies in gynecological cancers, with particular attention to clinical trials, preclinical studies, and reviews discussing mechanisms, outcomes, and challenges. Our synthesis reveals that immune checkpoint blockade agents, such as nivolumab and pembrolizumab, demonstrate promising responses in specific patient subsets, notably those with HPV-associated tumors and high mutational burdens. Despite these advances, significant limitations persist, including immune-related side effects, treatment resistance, and patient heterogeneity. Ongoing efforts to identify predictive biomarkers and develop combination therapies aim to overcome these hurdles. In conclusion, immunotherapy holds substantial potential for improving outcomes in gynecological cancers. Nonetheless, further research is needed to elucidate mechanisms of resistance, optimize patient selection, and establish effective treatment protocols.