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Pembrolizumab plus radiation falls short in endometrial cancer. A phase 3 trial found that adding the immunotherapy drug pembrolizumab (Keytruda) to radiation therapy did not significantly improve recurrence-free survival at 3 years in patients with early-stage, high-intermediate–risk dMMR endometrial cancer. The combination also came with more side effects, leaving radiation alone as the standard of care.
A major phase 3 trial has found that adding the immunotherapy drug pembrolizumab (Keytruda) to standard radiation therapy doesn't meaningfully improve outcomes for patients with early-stage, high-intermediate–risk mismatch repair–deficient (dMMR) endometrial cancer. The NRG-GY020 trial, presented at the 2026 ESMO Congress, enrolled 168 patients across 75 sites and randomly assigned them to receive radiation alone or radiation plus pembrolizumab.
The results were clear: recurrence-free survival at 3 years was nearly identical between the two groups, and the combination came with a notably higher burden of side effects — including fatigue, rash, and immune-related complications — leading 23 patients in the combination arm to discontinue treatment due to adverse effects. Investigators concluded that radiation alone remains the standard of care.
By the Numbers:
Why it matters: dMMR endometrial cancer carries a higher risk of recurrence than other subtypes, and there was real hope that adding an immunotherapy agent could close that gap. This trial suggests that, at least in early-stage disease, the added toxicity of pembrolizumab isn't justified by the modest — and statistically insignificant — benefit observed.
