Advanced Endometrial Carcinoma: Systemic Therapy & Patient Prognosis

What patients can expect in terms of prognosis when receiving systemic therapy for advanced endometrial cancer.

Robert L. Coleman, MD, FACOG, FACS: Prognosis is something that’s regularly updated. When we started this case, this patient was diagnosed as having a grade 2, stage IB endometrioid microsatellite-stable endometrial cancer. She had surgery and evidence of no metastatic disease by the assessment and was treated with vaginal cuff brachytherapy. Our estimation of her prognosis at that stage was quite good. We would have expected that her potential for recurrence was probably on the order of 20% or 25%, and unfortunately, she fell into that category. Her prognosis then would be reevaluated at the first recurrence. At that point, she had relatively limited disease, but it was definitely present.

At first recurrence, the prognosis drops. We know that depending on the disease volume, if those patients aren’t candidates for surgery, then we’re essentially looking at chemotherapy. And while we have high relative response rates in that setting, the long-term cures reduce by as much as 50%. Her prognosis has definitely decreased because she recurred. She did respond to treatment, but then she recurred again. In that situation, she has a much worse prognosis than we started with, because she’s now recurred twice and demonstrated the biology of this disease.

Fortunately, she’s getting a good treatment that’s associated with a progression-free survival of about 7 months, which is good on the median. Her overall survival would be around a year and a half, which is better than with the alternatives. But long-term outcomes are still going to be under 50% with respect to survivorship, meaning over 2 years. Prognosis is a moving target in this situation. You can see how prognosis was affected by the previous histories that preceded when we make that estimation of prognosis.

Transcript edited for clarity.

Initial Presentation

  • A 64-year-old postmenopausal woman presented with abnormal uterine bleeding for about 2 months. She has two grown children, underwent menopause at 57 years of age, has no known family history of cancer.
  • PMH: BMI is 32, and she has hypertension that is controlled with medication
  • PE: Notable for large uterus and right lower quadrant abdominal tenderness on palpation

Clinical work-up

  • Endometrial biopsy: endometrioid adenocarcinoma, FIGO grade 1
  • Surgery: ELAP TAH BSO with bilateral pelvic node dissection
  • Pathology: grade 2 endometrioid adenocarcinoma, 18 negative pelvic nodes, invasive 2.1 cm of 2.3 cm myometrium
  • Molecular testing shows MSS, MMR proficient, and HER2-


  • Postoperative radiotherapy: vaginal cuff brachytherapy to a dose of 21 Gy in 3 fractions
  • 14 months after completing radiotherapy, she presented with new RLE edema and right hydroureter
  • She then was treated with carboplatin/paclitaxel chemotherapy which was well tolerated
  • Nine months later the patient has disease relapse with metastases to the paraaortic lymph nodes and lung
  • She is now treated with lenvatinib/pembrolizumab
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