pairingsPairing
Lenvatinib + pembrolizumab (pMMR endometrial cancer after platinum)
An anti-angiogenic pill makes immunotherapy work in endometrial cancers that would otherwise ignore it, at the cost of significant side effects.
KEYNOTE-775: OS 18.3 vs 11.4 months versus chemotherapy in all comers and 17.4 vs 12.0 months in pMMR disease. Dose reductions in ~67%; discontinuation for toxicity in ~33%. First-line LEAP-001 failed to beat chemotherapy, so the pairing lives in the second line.
Rationale
VEGFR inhibition reduces immunosuppressive myeloid cells and normalises vessels for T-cell entry; the combination overcame PD-1 monotherapy's ~13% response rate in pMMR disease.
Evidence
Phase 3 OS benefit (second line); negative first-line trial.