Endometrial Carcinoma Treatment Advances - Episode 6
Reflections on the future management of endometrial cancer and practical advice for practicing oncologists.
Brian M. Slomovitz, MD, MS, FACOG: The future is bright for the treatment of endometrial cancer. We’re going to move toward biomarker-driven therapies for all patients. What do I mean by that? We’re going to be doing studies in newly diagnosed patients, eliminating chemotherapy and giving immunotherapies—or hormonal therapies, for that matter—based on biomarker-driven profile. In a world of immunotherapies, we’ve done a great job with lenvatinib in combination with pembrolizumab, but there are other ongoing studies looking at newer combinations of biomarker-driven therapies with immunotherapy to better the response rates and cure this disease.
One trial being done is a collaboration between the Alliance Foundation and Genentech, which is looking at immunotherapy atezolizumab in combination with a biomarker-driven therapy based on the biological makeup of the tumor. Hormonal therapy for ER [estrogen receptor]–positive cancers is going to continue to progress with research. We have tamoxifen, aromatase inhibitors, and Progestin, but there’s a new class of drugs called SERDs [selective ER degraders], which will be looked at to better manage this disease with hormonal manipulation. Biomarker-driven therapies—for example, CDK4/6 inhibitors and others—are going to continue to evolve and work to eradicate the deaths from this disease, but [they will also] help women get treated without chemotherapy, which has its own set of adverse effects.
As far as where we are now with endometrial cancer and how I treat my patients, I encourage testing for mismatch repair [MMR] proteins at the time of diagnosis. We’re using immunohistochemical screening, which tests for MLH1, MSH2, MSH6, and PMS2 to determine if there’s a loss of expression. If there’s a loss of expression, these tumors are deemed deficient in MMR proteins and are more amenable to single-agent immunotherapy in treatment. In initial diagnosis, we’re also doing estrogen and progesterone receptor testing to determine if hormonal therapy would eventually work or if we need it for treatment.
By doing this type of screening, we can better identify which treatments work best for individual patients. Carboplatin and paclitaxel work well for some patients, but we can do better. The way we’re going to do better is by taking advantage of the science that we have and to incorporate new treatment strategies. This will be based on matching the findings from that science with the patient’s individual tumor. It’s the ultimate in personalized medicine.
Transcript edited for clarity.