Medical Oncologist
Gynaecological cancers
Targeted Therapy for — Cervical and Endometrial Cancer
Before targeted therapy begins for endometrial or cervical cancer, your tumour tissue is tested for specific mutations. Those results — not the cancer type alone — decide which treatment your oncologist recommends.
Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed August 2026
- Testing comes first — Biomarker results from your biopsy tissue determine whether targeted therapy applies to you and which agent fits your tumour.
- Different markers for each cancer — Endometrial cancer is tested for MMR status, HER2, and POLE; cervical cancer is tested for PD-L1 and MSI.
- Given as day care — Most targeted therapies for these cancers are given as infusions. You come in and go home the same day.
- A negative result still leaves options — If none of the markers are positive, your oncologist moves to the treatment that the evidence supports for your specific tumour.
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Targeted therapy for endometrial cancer is selected based on biomarker testing of your tumour tissue. The key markers tested include mismatch repair status, HER2, and POLE mutations. For cervical cancer, PD-L1 expression and MSI status are checked. Your oncologist uses these results alongside your stage and general health to decide which treatment is appropriate.
Which mutations are tested before targeted therapy begins?
For endometrial cancer, four markers are commonly assessed. Mismatch repair status — reported as dMMR or MMR-proficient — tells your team whether the tumour's DNA repair system is working correctly. HER2 expression is checked in serous-type endometrial tumours. POLE mutations and tumour mutational burden may also be tested, because these affect which treatment the evidence supports.
For cervical cancer, the main markers are PD-L1 expression — reported as a combined positive score — and MSI status. VEGF is a different kind of target: it is a pathway that is blocked in advanced cervical cancer regardless of biopsy markers, so it does not appear as a positive or negative result on your pathology report.
Which tests are ordered depends on your cancer type, stage, and what treatment is being considered. Your oncologist will explain which panel was run and what each result means for your situation specifically.
What do the terms on your pathology report mean?
- dMMR (deficient mismatch repair) / MSI-H (microsatellite instability-high)
- The tumour's DNA repair system is not working correctly. This leads to a high number of mutations in the tumour, which can make checkpoint immunotherapy more likely to be effective. NCCN and ESMO recommend testing for this in all endometrial cancers at diagnosis.
- MMR-proficient / MSS (microsatellite stable)
- The mismatch repair system is intact. The tumour has fewer mutations. This does not rule out targeted therapy entirely, but it means different markers or drug combinations are considered instead.
- POLE mutation (ultramutated)
- A change in the POLE gene that causes an exceptionally high number of mutations in the tumour. Tumours with this finding are described as ultramutated and are classified separately from other endometrial cancers under ESMO's molecular grouping.
- HER2 overexpression
- The tumour produces large amounts of a protein called HER2. This is found most often in serous-type endometrial cancer. Drugs that block this protein can be added to standard treatment when this is confirmed on testing.
- PD-L1 (combined positive score, or CPS)
- A score that measures how much PD-L1 protein is present on tumour and immune cells. Used mainly in cervical cancer. A positive CPS indicates that checkpoint immunotherapy is more likely to help, according to NCCN and ASCO guidance.
- VEGF pathway
- A system that tumours use to grow new blood vessels. Drugs that block VEGF are used in advanced cervical cancer to slow tumour growth. This is not a biopsy marker — it is a treatment target used based on stage and prior therapy, not a test result.
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Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
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Dr. Mohammed Imran
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Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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How does the process from testing to treatment work?
Tissue from your biopsy is sent to the laboratory
Testing is done on tumour tissue already collected, usually from your diagnostic biopsy. A new biopsy is only needed if the sample was too small or the disease has changed since diagnosis.
The laboratory analyses the relevant markers
For endometrial cancer, this typically includes MMR status, HER2, and where relevant, POLE mutation and tumour mutational burden. For cervical cancer, PD-L1 and MSI are checked.
Your oncologist reviews the results in context
Biomarker results are read alongside your cancer type, stage, and general fitness. A positive marker is necessary for certain treatments but not sufficient on its own — the full picture guides the decision.
A treatment plan is proposed and explained
Your oncologist explains which targeted or immunotherapy agent is indicated, whether it is combined with chemotherapy, what the schedule looks like, and what side effects to watch for.
Treatment is given in a day care setting
Most targeted therapy and immunotherapy infusions for these cancers are administered as day care. You come in, receive the infusion, and go home the same day.
Response is monitored by scan and blood test
Imaging scans assess how the cancer is responding, at intervals set by your team. Blood tests are checked regularly for early signs of side effects between appointments.
What does treatment actually involve day to day?
Most targeted therapies and immunotherapy agents for endometrial and cervical cancer are given as intravenous infusions on a schedule your oncologist sets. You come in for the infusion and go home the same day.
Some regimens include an oral targeted therapy taken at home on a daily basis. Your team will explain when to take it, what to avoid, and which side effects to report promptly rather than waiting for your next appointment.
Targeted therapy side effects differ from chemotherapy side effects. Hair loss is much less common. The specific side effects to watch for depend on which drug class you are on — your oncologist will go through this list with you before treatment starts.
Did you know?
Endometrial cancer has one of the highest proportions of MSI-H tumours of any solid cancer. This is why NCCN and ESMO now recommend mismatch repair testing for every newly diagnosed endometrial tumour — not only advanced cases.
If your report says dMMR or MSI-H, that result is directly relevant to the treatment options your oncologist will discuss with you.
Source: NCCN Guidelines — Uterine Neoplasms; ESMO Clinical Practice Guidelines for Endometrial Cancer
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Common questions
Frequently asked questions
How is targeted therapy different from chemotherapy for endometrial cancer?
Chemotherapy attacks fast-dividing cells throughout the body. Targeted therapy works more specifically — it blocks a particular protein or pathway that your tumour depends on. The side effects are different as a result: hair loss is much less common with most targeted agents. The specific side effects depend on which drug is used, and your oncologist will explain what to watch for before treatment starts. The two approaches are sometimes used together rather than as alternatives.
What if my tumour does not have any of the tested markers?
A negative result on all markers does not mean there is no treatment. It means the drugs tied to those markers are not appropriate for your tumour. Your oncologist will recommend a different approach — which may include chemotherapy, a different combination, or clinical trial options. A negative biomarker result is information about which treatment fits your tumour best, not a statement about your prognosis.
How long does biomarker testing take?
Results usually take one to two weeks from when the laboratory receives the sample. Testing is generally done on tissue already collected during your diagnostic biopsy, so no new procedure is needed in most cases. If the original sample was too small, a repeat biopsy may be required before testing can be completed. Ask your team when the sample was sent and when results are expected, so you are not waiting without a timeline.
Can targeted therapy be used at any stage of endometrial cancer?
It depends on the marker and the drug. Some targeted therapies are indicated for advanced or recurrent disease only; others are used earlier. MSI-H status is relevant at several stages according to NCCN and ESMO guidance, while HER2-directed treatment is currently most established in advanced serous-type disease. Your oncologist will tell you which options apply to your specific stage and what you have received before.
Is the targeted therapy for cervical cancer the same as for endometrial cancer?
No — the drugs and markers tested are different. For cervical cancer, PD-L1 expression and MSI status guide immunotherapy decisions, and VEGF-directed therapy is used in advanced disease regardless of biomarker status. For endometrial cancer, mismatch repair status, HER2, and POLE mutation are the main markers. The two cancers share some drug classes but not the same indications or testing panels.
Will I need to be tested again if the cancer comes back?
Possibly. If your cancer recurs, your oncologist may recommend a repeat biopsy and fresh testing, because tumours can change their molecular characteristics over time and a result from an earlier biopsy may not reflect the current disease. New treatment options also emerge as evidence develops, so a marker that was not relevant at first diagnosis may become relevant at recurrence. This is a reasonable question to raise at your review appointment if the cancer returns.