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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