Endometrial Carcinoma Treatment Advances - Episode 1
Expert perspectives on the endometrial cancer treatment landscape in light of approved therapies and drug classes.
Brian M. Slomovitz, MD, MS, FACOG: Endometrial cancer is the most common gynecologic malignancy. Fortunately, most women who are diagnosed with endometrial cancer are treated with surgery alone. Sometimes, there may be a hysterectomy, radiation, orchemotherapy. There’s a subset of women who recur with widespread metastases or who present with metastases at the time of diagnosis. There are several treatment options for these patients, and we’re getting better and more advanced at the options that we offer.
The first option is chemotherapy. The standard of care is carboplatin and paclitaxel for metastatic endometrial cancer. Other options include hormonal therapies. Similar to breast cancer, endometrial cancers have estrogen and progesterone receptor positivity and are amenable. It’s a good disease to be treated with hormonal manipulation. The standard of care is Megace, or progestin, and occasionally we give it with alternating demoxepam. In addition, immunotherapy has recently been in the spotlight for treating women with endometrial cancer.
Although it’s not in the first line yet, we’re treating women who have microsatellite instability, which is a biomarker-driven therapy with single-agent checkpoint inhibitors. Two of them have FDA indications, pembrolizumab and dostarlimab. In patients who don’t have microsatellite instability, we’re using pembrolizumab in combination with a tyrosine kinase inhibitor, lenvatinib. Finally, we’re also doing biomarker-driven therapies for women with systemic disease. The 2 that I would say have been best evaluated are looking at mTOR inhibitors in combination with aromatase inhibitors. That’s 1 of my areas of research. In addition, there are sufficient data looking at CDK4/6 inhibitors with letrozole for women with systemic disease presented at the European meeting last year. The bottom line is that there are a lot of options. It’s always good to have a lot of options, and we’re working to hopefully eradicate death from this horrible disease.
When we’re deciding which treatments to offer our patients with endometrial cancer, there are a lot of factors that we take into consideration. Obviously, age is important. Are they living by themselves? Are they doing daily activities if they’re living on their own? Are they bedridden most of the time? In addition, we look at sites of recurrence for where the disease is. We look at how long it took from their initial diagnosis for them to recur. In addition, we look at pathological factors: type of histology, lymph node involvement, or grade of the tumor. Finally, we’re dividing into 1 of 4 molecular subtypes. This is based on if it’s what we call hot or amenable to immunotherapy, or a cold tumor that’s not amenable to chemotherapy. We’re determining that based on next-generation high-throughput sequencing.
Transcript edited for clarity.