Recurrent endometrial cancer: Which therapy for whom?

Recurrent endometrial carcinoma is associated with a 5-year survival rate of 20-25%. How can longer and progression-free survival be achieved?

Treatment paths for recurrent endometrial carcinoma

In chemotherapy-naïve patients, the combination of platinum-containing chemotherapy and immunotherapy should be considered.
In the case of HER2+ status, the recombinant, humanised IgG1 antibody trastuzumab should also be used.
If the oestrogen receptor status is positive (ER+), endocrine therapy should be carried out.
Pembrolizumab can and should be administered after platinum-containing chemotherapy.

Recurrent endometrial cancer: what is the prognosis?

In general, recurrent endometrial cancer is associated with a 5-year survival rate of around 20 to 25 per cent. However, new studies suggest more favourable outcomes as a result of improved treatment options, which may lead to a longer PFS and longer survival times.

Patients without previous chemotherapy: how to treat?

There are various treatment approaches for patients with recurrent endometrial cancer:

Platinum-containing chemotherapy can be combined with immunotherapy. Study data show positive outcomes in terms of PFS and OS with this combination.
In the case of HER2 positivity, chemotherapeutic treatment should be supplemented with trastuzumab.
Endocrine treatment should be considered for those with positive oestrogen receptor status.

And what to do after chemotherapy?

If the patient has already undergone platinum-containing chemotherapy and recurrences still occur, the procedure changes slightly.

Endocrine therapy should be given for ER+.
For HER2 positivity (IHC 2+ or 3+), trastuzumab and/or deruxtecan is recommended.
If a rare NTRK mutation is present, the treatment of choice is larotectinib or entrectinib.
In these patients, platinum-containing chemotherapy is replaced by pembrolizumab with or without lenvatinib.

There is hope on better outcomes

There are updated treatment recommendations for patients with recurrent endometrial cancer. Depending on the receptor status and previous therapy, there are different treatment paths. In general, patients should also be included in clinical trials where possible. The overall prognosis is still rather negative, but new therapeutic approaches offer improved outcomes in terms of PFS and OS.

Source

Choong, Grace, M.D., Mayo Clinic Rochester, USA, Charité-Mayo-Conference distilled 2024, What is the Best Therapy for Relapsed Endometrial Cancer? Chemotherapy Pretreated or Naïve?, 13.04.2024