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Vitamin D is a fat-soluble vitamin and steroid hormone precursor that functions as an agonist of the Vitamin D receptor (VDR). In the context of the PRIMMO Phase II clinical trial (NCT03192059) conducted by University Hospital, Ghent, Vitamin D is utilized as a key component of a five-drug immunomodulatory cocktail. This cocktail, which also includes aspirin, lansoprazole, low-dose cyclophosphamide, and curcumin, is administered to patients with advanced or refractory cervical cancer, endometrial cancer, or uterine sarcoma. The regimen is designed to modulate the tumor microenvironment by inhibiting myeloid-derived suppressor cells (MDSCs) and interleukin-6 (IL-6) production, thereby enhancing T-cell function and priming the immune system for treatment with pembrolizumab and stereotactic body radiation therapy (SBRT). Although the PRIMMO trial did not meet its primary efficacy endpoint, Vitamin D's role in this multimodal approach was to overcome immune resistance in gynecological malignancies.
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