My Treatment Approach: Metastatic Endometrial Cancer - Episode 4
Considerations for Second-Line and Higher Treatment of Recurrent mEC
Drs Moore and O’Malley discuss the second-line and higher targeted treatment options that they’d consider for patients with mEC who develop recurrent disease on or after chemotherapy.
Transcript:
Kathleen Moore, MD: What would be your thought process for a patient in the recurrent setting who has mismatch repair-deficient disease? Or what other targeted approaches might you take in the recurrent setting based on biomarkers and other factors?
David O’Malley, MD: It’s great. I think if they’re deficient, with what’s available, pembrolizumab or dostarlimab, it’s brainless for me. If they’re proficient: lenvatinib, pembrolizumab. I think when you see these patients, treating them with the best therapies at that point. Again, in that patient recurrence, I send next-generation sequencing. I’m looking for targeted options for these patients. I do not retreat with carboplatin and paclitaxel. I think the data, I do not believe the platinum sensitive, platinum recurrence, we cannot extrapolate from ovarian cancer. If a patient’s been out 2, 3, 4 years, then maybe I would treat. But in that same instance, I can always go back to carboplatin-paclitaxel. Utilizing the immune therapy in that setting is absolutely what I would do even if it had been 1 or 2 years, getting that option on board and being able to go back to carboplatin-paclitaxel in the future.
Kathleen Moore, MD: I agree. It’s interesting now; when both you and I were younger there wasn’t any discussion of second-line treatment for endometrial cancer after the first metastatic setting because we had such ineffective treatments. Our best regimen…was weekly paclitaxel, with a response rate of about 15%, and then there was nothing. Our patients suffered for that lack of effective therapies. Now here we are with lenvatinib-pembrolizumab vs pembrolizumab or dostarlimab in the second-line setting. Maybe that will move to the front, but we have it in the second line right now. And now we have patients wondering what their third-line therapy is going to be, or their fourth-line therapy. So we are moving the needle a little in terms of being able to continuously treat patients. It’s not as robust as with ovarian cancer, where patients can get 5, 6, or 7 lines, but we are moving it out.
Transcript edited for clarity.