Optimizing Management Strategies for Advanced Endometrial Cancer Progression After IO-Chemo

Summary for Physicians: Treating Patients With Advanced EC Who Progress After IO-Chemotherapy

For patients with advanced EC who progress after IO therapy combined with chemotherapy, the treatment strategy typically involves considering several options based on individual patient factors, tumor characteristics, and prior treatment response.

Assessing Tumor Characteristics and Biomarkers:

 remains essential to guide decision-making. Key biomarkers such as mismatch repair deficiency status (dMMR), microsatellite instability (MSI), tumor mutational burden, and others should be reassessed to guide further treatment strategies.

, further IO options or clinical trial enrollment may be considered, as they might still benefit from additional immunotherapy.

If a patient did not respond to initial IO therapy (eg, pembrolizumab or nivolumab), 

 are becoming an important option, particularly for dMMR or MSI-H tumors.

 (such as additional PD-1/PD-L1 inhibitors) could be considered, especially if the patient has not previously received certain IO regimens.

Chemotherapy and Other Targeted Therapies:

For patients who do not respond to IO therapies, switching to traditional chemotherapy (such as 

, or new IO combinations should be explored if available.

Treatment decisions should be individualized, considering the patient’s response to previous therapies, performance status, comorbidities, and preferences.

 is key in these complex cases, with input from pathologists, geneticists, and supportive care teams to ensure the best possible outcomes.

In summary, treating patients with advanced EC who progress after IO-chemotherapy requires a multifaceted approach that includes reassessing tumor characteristics, considering alternative immunotherapy or targeted therapies, and exploring clinical trials. Personalizing treatment plans based on biomarker status and previous responses remains crucial in optimizing care.

Videos

Panelists discuss how treating patients with advanced endometrial cancer (EC) who progress after immune-oncology (IO)-chemotherapy involves reassessing tumor biomarkers, considering alternative immunotherapies or targeted treatments, and personalizing care based on prior treatment responses and individual patient factors.

Overview of Current Treatment Landscape of Advanced Endometrial Cancer

Summary for Physicians: Current Treatment Landscape of Advanced EC

The treatment landscape for advanced EC has evolved significantly, incorporating both traditional therapies and newer immunotherapeutic approaches.

For advanced or recurrent EC, platinum-based chemotherapy (eg, carboplatin and paclitaxel) remains the standard first-line treatment. This approach is commonly used for patients with nonmismatch repair deficient (non-dMMR) tumors.

ICIs, such as pembrolizumab and nivolumab, have emerged as a promising treatment for patients with dMMR or microsatellite instability-high (MSI-H) tumors. These agents offer significant benefits, especially in the recurrent or metastatic setting.

The combination of pembrolizumab with lenvatinib, an antiangiogenic agent, has demonstrated efficacy in dMMR and MSI-H EC, especially in cases that have failed prior chemotherapy.

Identifying patients who will benefit most from immunotherapy is a key challenge. Biomarker testing, such as mismatch repair status and MSI, plays a crucial role in predicting response to immunotherapies.

While immunotherapies offer new opportunities, adverse effect management and the optimal sequencing of therapies are ongoing challenges.

In summary, the integration of immunotherapy into the treatment of advanced EC, particularly for dMMR or MSI-H tumors, marks a significant shift in therapeutic options, alongside the continued role of chemotherapy. Ongoing research and biomarker-driven approaches are crucial to optimizing outcomes for patients with advanced EC.

Panelists discuss how the integration of immunotherapy, particularly immune checkpoint inhibitors (ICIs) and combination therapies, is transforming the treatment landscape of advanced endometrial cancer (EC), with a focus on biomarker-driven approaches and the ongoing role of chemotherapy.

John Chung-Kai Chan, MD

Articles

Optimizing Management Strategies for Advanced Endometrial Cancer Progression After IO-Chemo

Overview of Current Treatment Landscape of Advanced Endometrial Cancer