MMRp Recurrent Endometrial Carcinoma: What is a Typical Patient Presentation?


Experts Michael J. Birrer, MD, PhD, and Kimberly Halla, MSN, FNP-C, share insight to a typical patient presentation of MMRp recurrent endometrial carcinoma.


Robert Coleman, MD, FACOG, FACS: Mike, is this a typical presentation for a patient who has uterine-confined endometrial cancer?

Michael J. Birrer, MD, PhD: This a typical presentation with a couple of caveats. First, from a clinical biologic standpoint, she has a fairly high BMI [body mass index] and probably elevated levels of estrogen. The original biopsy is FIGO [International Federation of Gynaecology and Obstetrics] grade 1, which is a well-differentiated tumor. I like this case because it demonstrates another typical feature: when the tumor is removed and on the pathology table, you get an upgrade on the tumor. This happens very typically. Now it’s grade 2, and it’s fairly invasive—about an 80% invasion. To me, she’s fairly high risk, particularly now that the grade has gone up. What’s unusual is that she’s ER [estrogen receptor] negative. I would have said, “Hey, she’s going to have some ER positivity.” That’s a little unusual. I wouldn’t consider it a very strong independent prognostic feature, but it’s not great. If she was ER positive and FIGO grade 1, then I’d feel better…. I love your intro because 10 years ago, we would’ve spent about 1 minute on this case. Everybody got treated the same. It was terrible. Now, we need to know the microsatellite-stable features, because those are going to dictate things.

Robert Coleman, MD, FACOG, FACS: Kimberly, you probably get calls on these patients. Usually, when they have postmenopausal bleeding, they’re panicking. How do you walk these people off the ledge or keep them from walking off the ledge?

Kimberly Halla, MSN, FNP-C: We make sure we have that constant communication with patients throughout their treatment, from the start. We’re talking with them about surgery alternatives and chemotherapy. We’re giving them options and a treatment plan that will give them a direction they’ll be able to go. We talk about molecular, about what their options are, and give them the education they deserve.

Robert Coleman, MD, FACOG, FACS: There are going to be a lot of questions from the patient about that. Mike, we have information on ER, on HER2 [human epidermal growth factor receptor 2], on dMMR [deficient mismatch repair] status. Is there anything else we’d order for this patient, in terms of molecular testing?

Michael J. Birrer, MD, PhD: That’s a great question. Before I jump into that, I want to go back to the other question. As the audience knows, and as you know, if you go across the United States, 75% of these patients are going to present with uterine-contained tumor. In our practice, it’s lower. It’s about 60% because we’re in Arkansas. There aren’t too many games in this town. The limited patients stay in the community, and we get referred the more complicated cases. Only about 55% to 60% of patients are confined to the uterus.

Transcript edited for clarity.

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