Version June 2024
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 therapy 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:HER2: human epidermal growth factor receptor 2; MMR: mismatch repair; TMB: tumor mutational burden; pMMR: mismatch repair proficient; dMMR: mismatch repair deficient.
* Some experts may reasonably add pembrolizumab or dostarlimab for pMMR tumors; we await incorporation into guidelines or regulatory approval for use in this subset, however.
¶ 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.
Δ Refer to UpToDate topics on subsequent line systemic therapy for metastatic endometrial cancer.
◊ 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.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
