Selecting an Appropriate Second-Line Treatment for Metastatic Endometrial Cancer


Dr Robert Holloway explains what second-line treatment regimen he would have chosen for the patient with metastatic endometrial cancer in the presented case.

Case History

June 2021

A 71-year-old postmenopausal woman presented with intermittent uterine bleeding, increased urinary frequency, and cramping over the past 6 months.

  • She noted that she underwent menopause at 52 years of age
  • She is married and has 2 adult children
  • PMH: T1D since childhood, well-controlled
  • PE: Notable for uterine tenderness upon palpation
  • ECOG PS= 1
  • Chest/abdomen/pelvis CT revealed uterine and bladder masses
  • CA-125= 38.6 U/mL
  • Endometrial biopsy results:
  • Endometrioid adenocarcinoma
  • FIGO stage IVA
  • Grade 3 (poorly differentiated)
  • IHC testing revealed mismatch repair proficiency (pMMR) and estrogen receptor (ER) negativity

July 2021:

  • Patient started carboplatin/paclitaxel (6 cycles), which was well-tolerated
  • Patient was scheduled for follow-up visits every 3 months after completion

May 2022 (6 months post–chemotherapy completion):

  • CA-125 level increased to 42.1 U/mL
  • CT revealed that the previous bladder metastatic mass increased slightly in size
  • The patient discussed targeted systemic therapy options with her clinician, and she expressed the desire to spend as much time as possible with her grandchildren.
  • They jointly decided to trial lenvatinib/pembrolizumab, with instructions to continue follow-up visits every 3 months.
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