Selecting an Appropriate Second-Line Treatment for Metastatic Endometrial Cancer

EP: 1.Case Overview: A 71-Year-Old Woman with Metastatic Endometrial Cancer

EP: 2.Presentation of Endometrial Cancer and MMR Testing

EP: 3.Available Systemic Therapy Options for Patients with MMR-Proficient Metastatic Endometrial Cancer

EP: 4.KEYNOTE-775: Lenvatinib/Pembrolizumab in Patients with Advanced Endometrial Carcinoma

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EP: 5.Selecting an Appropriate Second-Line Treatment for Metastatic Endometrial Cancer

EP: 6.Second-Line Treatment Goals and Adverse Event Management for Patients with Metastatic Endometrial Cancer

EP: 7.Racial Disparities and Unmet Needs in Endometrial Cancer

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.