Determining Subsequent Therapies Based on Patient’s Prior Treatment History in Advanced EC

Summary for Physicians: The Role of Prior Treatment History in Determining Subsequent Therapy for Advanced EC

A patient’s prior treatment history plays a crucial role in determining subsequent therapy for advanced EC. Key considerations include the following:

• Response to Previous Therapies:
  • Response to prior treatments significantly influences decisions for subsequent therapy. If a patient responded well to initial chemotherapy or immune-oncology (IO) therapy, clinicians may opt to continue with the same therapy or use similar agents in the next line of treatment.
  • For patients who experienced disease progression during or after initial treatments, clinicians may look for alternative options, such as different chemotherapy regimens, combination therapies, or novel agents.
• Sequencing of IO and Chemotherapy:
  • In cases where IO therapy (eg, pembrolizumab or nivolumab) was used in combination with chemotherapy, the sequence in which these treatments were administered can impact decision-making. If chemotherapy was used first and the patient progressed, switching to IO therapy or combining it with targeted agents such as lenvatinib may be considered.
  • For patients who previously did not respond to IO therapy (especially if they were treated with IO monotherapy), a switch to different combinations or targeted therapies may be necessary.
• Prior Toxicity and Adverse Effects:
  • Toxicity history from previous treatments (eg, chemotherapy or IO therapies) can influence treatment choices. If a patient had significant adverse effects, alternative therapies that may be less toxic or that provide a different mechanism of action (such as targeted therapies) might be considered.
  • For example, if a patient experienced severe immune-related adverse events from IO therapy, clinicians may consider reducing the dose or discontinuing IO therapy in favor of other treatment approaches.
• Biomarker Status After Prior Treatments:
  • The biomarker status (eg, mismatch repair deficiency [dMMR], microsatellite instability [MSI], or tumor mutational burden) from previous treatments can provide insights into how the tumor may behave in response to subsequent therapies.
  • For instance, if a patient’s tumor was dMMR or MSI-high and had a favorable response to IO therapy initially, these biomarkers can help guide the use of further IO therapies or the decision to combine them with other treatments, such as lenvatinib.
• Previous Use of Targeted Therapies:
  • For patients who have previously received targeted therapies (eg, PI3K inhibitors or antiangiogenic agents), the effectiveness of those treatments and any emerging resistance can influence the choice of subsequent therapies. If resistance develops, alternative therapies or novel combinations may be considered.
• Clinical Trial History:
  • Patients who have participated in clinical trials may have received experimental treatments that can influence subsequent therapy choices. The outcomes of these trials, as well as the patient’s response to investigational agents, may guide future therapeutic decisions, particularly if the patient had a positive response to a trial therapy.

In summary, a patient’s prior treatment history is integral to guiding subsequent therapy decisions in advanced EC. Clinicians must consider the response to previous therapies, toxicity, biomarker status, and clinical trial participation to tailor treatment plans effectively, optimizing outcomes and minimizing unnecessary treatments.