Real-World Use of ICI in Advanced or Recurrent Endometrial Cancer

Summary for Physicians: Interpretation of Real-World Use of ICIs in Advanced or Recurrent EC

Dr Birrer’s question to Dr Chan regarding the real-world use of ICIs in advanced or recurrent EC pertains to how findings from real-world studies impact clinical practice and treatment strategies.

• Real-World Evidence Insights:
  • Real-world studies provide valuable information about how ICIs (eg, pembrolizumab and nivolumab) perform outside the controlled environment of clinical trials. These studies often reflect a more diverse patient population, including those with comorbidities or other factors that may not be fully represented in clinical trials.
  • Dr Chan may discuss how ICIs have shown efficacy in real-world settings, particularly in patients with mismatch repair deficiency (dMMR)/ microsatellite instability-high endometrial cancer. These patients, who tend to have a better response to IO therapies, are often the focus of real-world evidence showing favorable outcomes in both the advanced and recurrent settings.
    
• Effectiveness and Limitations:
  • Real-world data can confirm the effectiveness of ICIs but may also highlight the limitations in certain subgroups. For instance, patients with non-dMMR tumors may show less benefit from IO therapy, emphasizing the importance of biomarker-driven patient selection.
  • Real-world use also underscores adverse events, which might not always be fully captured in clinical trials. By analyzing adverse effects and patient outcomes in real-world settings, clinicians can better manage and anticipate challenges when using ICIs in routine practice.
    
• Impact on Treatment Sequencing:
  • The findings from real-world data may help inform how ICIs fit into the broader treatment landscape, particularly regarding sequencing after first-line chemotherapy or as part of combination therapies. This could influence decisions about whether to initiate ICI therapy earlier in the treatment course or reserve it for patients with specific biomarkers or disease characteristics.
    
• Clinical Practice Adjustments:
  • Dr Chan may highlight how real-world studies can influence clinical practice by supporting the integration of ICIs earlier in treatment regimens, or potentially advocating for combination therapies (eg, pembrolizumab and lenvatinib) in patients who may not respond well to monotherapy.
  • These findings also underscore the need for ongoing patient monitoring to identify any potential toxicity early, improving the ability to balance efficacy and quality of life in real-world settings.

In summary, Dr Chan’s interpretation of the real-world use of ICIs in advanced or recurrent EC would likely focus on how this data supports and refines treatment strategies, especially for biomarker-driven therapy, and how real-world insights help manage treatment sequencing, patient outcomes, and adverse events more effectively in everyday clinical practice.