The Evolving Endometrial Cancer Treatment Paradigm

Eirwen M. Miller, MD, gynecologic oncologist at Allegheny Health Network, explains how the treatment of endometrial cancer has evolved in recent years.

Miller explains that 2 presentations given at the Society of Gynecologic Oncology (SGO) Annual Meeting have redefined the standard of care for advanced endometrial cancer. In the phase 3 NRG-GY018 (NCT03914612), the addition of pembrolizumab (Keytruda) to chemotherapy achieved a significant improvement in progression-free survival (PFS) in comparison with chemotherapy alone in patients with advanced or recurrent disease. Similarly, in the phase 3 ENGOT-EN6-NSGO/GOG-3031/RUBY trial (RUBY; NCT03981796), the addition of dostarlimab-gxly (Jemperli) to carboplatin and paclitaxel achieved a significant improvement in PFS compared with carboplatin and paclitaxel alone in patients with advanced or recurrent endometrial cancer.

Miller notes that the PFS benefit shown with both anti-PD-1 therapies carried over into the mismatch repair deficient subgroups.

Transcript:

0:07 | The treatment of endometrial cancer today probably [is] astronomically more complicated than it was 3 or 4 years ago. The most recent publication publications came to us at SGO in March this year. The NRG-GY018 and RUBY studies were presented and simultaneously published, evaluating the role of immunotherapy in combination with chemotherapy followed by immunotherapy maintenance for patients with advanced-stage endometrial cancer. And, you know, each study had slightly different inclusion criteria and slightly different designs, but both demonstrated a progression-free survival benefit with the addition of immunotherapy.

0:54 | The most profound is what was seen in the patients that had mismatch repair deficient endometrial cancers, and that certainly will change our standard of care for that subgroup of patients. There is also a benefit, though more modest in the mismatch repair patient population, in the intention-to-treat populations of those studies. And, you know, that certainly will change the way we treat upfront endometrial cancer, giving thought to, you know, the addition of maintenance therapy. What is the role now of radiation therapy for [the] upfront management of advanced endometrial cancer?