Expert oncologist Bhavana Pothuri, MD, reviews the diagnosis and treatment of a 64-year-old woman who presents and recurs with mismatch repair-deficient (dMMR) endometrial cancer (EC).
Bhavana Pothuri, MD: Hello, I'm Bhavana Pothuri, I'm a GYN oncologist at the New York University Langone School of Medicine Perlmutter Cancer Center. I serve as the CTO [clinical trials office] medical director here. In addition, I also serve as the director of gynecologic oncology clinical research and I work with GOG Partners as an associate clinical trial advisor for ovarian and endometrial cancer. I'm also the director of diversity and health equity for clinical trials for the GOG Foundation. So today we're going to be discussing the case of a 64-year-old woman with endometrial cancer.
In August of 2020, a 64-year-old postmenopausal woman presented with abnormal uterine bleeding lasting for 4 months. She noted that she underwent menopause at the age of 55. She's a widow, has no children and lives alone. Her past medical history is significant for arthritis and obesity, with a BMI [body mass index] of 40. Her ECOG [Eastern Cooperative Oncology Group] performance status is 1. Her endometrial biopsy results noted an endometrioid adenocarcinoma FIGO [Federation of Gynecology and Obstetrics] stage 1A, grade 1, well differentiated. Immunohistochemical testing noted mismatch repair deficiency, or dMMR. The patient discussed the possibility of having surgery with her clinician but she cited concerns over anesthesia requirements, recovery time, and a lack of caregiver support.
In September of 2020, the patient started external beam radiation therapy. She received a total dose of 45 gray and 25 fractions with 1.8 gray per fraction over 5 weeks and the patient was subsequently scheduled for follow up visits every 3 months. In July of 2021, 9 months post external beam completion, the patient mentioned that she had been experiencing intermittent bleeding for the past 3 weeks. A CT [computed tomography] of the chest, abdomen and pelvis was performed and revealed that the patient had relapsed metastatic disease with 1 positive right external iliac lymph node. The patient was started on carboplatin and paclitaxel for 6 cycles, which was well tolerated. She then continued on follow up surveillance every 3 months.
In May of 2022, 6 months post her chemotherapy completion, a repeat CT scan demonstrated a positive right-internal iliac lymph node, in addition to the previously observed positive lymph node. The patient discussed targeted systemic therapy options, and she expressed concerns over the side effects that she had heard about. The patient then started on dostarlimab with instructions to continue follow up every 3 months.
Transcript edited for clarity.