Effectiveness of neoadjuvant chemotherapy with lenvatinib plus pembrolizumab in advanced endometrial cancer: a case report

BACKGROUND: A combination of lenvatinib and pembrolizumab is a viable treatment option for unresectable advanced endometrial cancer after platinum-based chemotherapy; however, its efficacy as neoadjuvant chemotherapy remains to be elucidated. CASE PRESENTATION: The patient was a 51-year-old Japanese woman with severe anemia and suspected endometrial cancer based on magnetic resonance imaging. Adenocarcinoma was detected in the endometrium and diagnosed as stage IVB (T3aN2M1) endometrial cancer. Hysterectomy was considered difficult; therefore, paclitaxel plus carboplatin was administered as neoadjuvant chemotherapy. During treatment, the patient experienced massive genital bleeding, which necessitated uterine artery embolization and blood transfusion. Following these interventions, the bleeding was drastically reduced, enabling the administration of five cycles of lenvatinib plus pembrolizumab. The tumor markedly shrank, allowing surgery to be performed. The removed uterus exhibited induration but no residual cancer. CONCLUSION: Lenvatinib plus pembrolizumab may represent a feasible neoadjuvant option for achieving tumor regression and enabling surgical resection with a pathological complete response in advanced endometrial cancer.