Comprehensive insight to the systemic treatment armamentarium available to patients with metastatic EC.
Bhavana Pothuri, MD: In terms of, “would I have added on brachytherapy to external beam,” I probably would've included vaginal brachytherapy as well. Something else that I would've considered is if this was a endometrial cancer that was confined to the endometrium without any myoinvasion, I would actually consider hormonal therapy in someone who was refusing surgical treatment.
At the present time, I think the standard of care still remains paclitaxel and carboplatin. This is what I would start with. The one thing I would consider is adding immunotherapy after a few cycles, given that her tumor is dMMR [mismatch repair deficient]. Hopefully we will have data from the ongoing studies, RUBY, DUO-E, and NRG-GY018, which will help us move immunotherapy into an earlier line of treatment.
There are currently 2 that are approved for this indication of dMMR endometrial cancer, pembrolizumab as well as dostarlimab. Both are PD-1 [programmed cell death protein 1] inhibitors that bind to PD-1 and block PD-1 and PD-L1 [programmed death-ligand] or PD-L2, and essentially restore the cytotoxic activity of T-cells and the immune system to fight cancer. There are other PD-1 inhibitors as well as PD-L1 inhibitors that have been studied in trials, but these are the 2 that are currently FDA approved and available for use as treatment in our patients.
Transcript edited for clarity.