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Systemic therapy for metastatic endometrial cancer

Systemic therapy for metastatic endometrial cancer
This algorithm represents a suggested approach. However, other approaches are also reasonable. For example, for select patients, endocrine therapy is an alternative to first-line chemotherapy, or it may be used as a later-line option for those who have progressed on chemotherapy- or immunotherapy-based options. Endocrine therapy is well tolerated and lacks the usual toxicities associated with cytotoxic chemotherapy. Approximately 15 to 30% of women respond to endocrine therapy.
Factors that may predict response to endocrine therapy include the following:
  • Grade 1 or 2 endometrioid endometrial cancer.
  • Asymptomatic or minimally symptomatic disease.
  • Hormone receptor-positive cancer (mixed data; some studies suggest increased response rates with endocrine treatment).
HER2: human epidermal growth factor receptor 2; dMMR: mismatch repair deficient; MSI: microsatellite instable; TMB: tumor mutational burden; MSI-H: microsatellite instability-high.
* In the absence of direct comparisons, a choice between pembrolizumab and dostarlimab for such tumors should be based on factors such as availability and cost.
¶ For patients who have relapsed with a treatment-free interval following carboplatin and paclitaxel of ≥6 months, we typically suggest retreatment with chemotherapy. Endocrine therapy represents an acceptable alternative for select patients. Although we have chosen an interval of 6 months as a cutoff, extrapolating from the definition of platinum sensitivity in ovarian cancer, high-quality data regarding platinum sensitivity are lacking in endometrial cancer. In reality, sensitivity is expected to be a continuum, and 6 months should not be considered an absolute condition for treatment decisions; other factors including patient preferences and tolerance of prior treatments should also be weighed.
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