Standard Treatments for Patients with Advanced Endometrial Carcinoma

EP: 1.Overview of Endometrial Carcinoma

EP: 2.Molecular Profiling and Risk Stratification in Advanced Endometrial Carcinoma

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EP: 3.Standard Treatments for Patients with Advanced Endometrial Carcinoma

EP: 4.KEYNOTE-775: Updates from SGO 2023

EP: 5.Patient Tolerability with Lenvatinib plus Pembrolizumab

EP: 6.Additional Highlights from SGO 2023

EP: 7.Future Directions in Advanced Endometrial Carcinoma

Transcript:

David O’Malley, MD: With regard to surgery on advanced cancer—endometrial cancer, I should say—we really don’t know if [the disease is] advanced until we do surgery. Rarely, we’ll pick it up on imaging. But even if the lymph nodes are involved, we try to clean those lymph nodes out, remove the uterus, remove the lymph nodes. If we do not think they’re surgically resectable or if there’s evidence of metastatic disease, especially large volume metastatic disease; in the upfront setting, those patients usually do receive neoadjuvant [therapy], though it’s a small group of patients. Then [an] attempt at…interval surgery, or tumor-reductive surgery. That’s a rare group of patients, though. In the recurrent setting, we do not usually recommend surgery unless there is localized disease. I’ve operated on many patients over the years with localized [disease]; for example, para-aortic lymph node metastases. If you have localized disease, it’s still within the treatment paradigm, and some…would even recommend it. But there is no trial that has looked at just chemotherapy,…or immunotherapy, as this case may be, vs surgery, but most of us would try to resect that disease and then use systemic and or local therapy there like radiation.

When we’re discussing advanced or recurrent endometrial cancer, we first have to utilize carboplatin-paclitaxel, the standard chemotherapy regimen. If they have had carboplatin-paclitaxel in the past, I then go to our available immune therapies. The 2 main classes of immune therapies are PD-1 inhibitors; dostarlimab and pembrolizumab for mismatch repair deficient patients or MSI [microsatellite instability] high, or pembrolizumab-lenvatinib for patients who are mismatch repair proficient. If the patients have had previous chemotherapy, I go right to the immune-based therapy.

Transcript edited for clarity.