Dr. Slomovitz on Sequencing Strategies in Endometrial Cancer

Brian M. Slomovitz, MD, gynecologic oncology, Broward Health, professor of obstetrics and gynecology, Herbert Wertheim College of Medicine, Florida International University, discusses sequencing strategies in endometrial cancer.

Historically, patients with advanced and recurrent endometrial cancer have received chemotherapy and radiation, says Slomovitz. However, findings from the phase 3 GOG-258 trial showed that chemotherapy plus radiation did not prolong relapse-free survival compared with chemotherapy alone in patients with stage 3 or 4A endometrial carcinoma. As such, waiting to give radiation therapy until a patient requires salvage treatment is an alternate strategy, explains Slomovitz.

Additionally, immunotherapy has demonstrated activity in patients with microsatellite instability—high (MSI-H) endometrial cancer. In 2017, the checkpoint inhibitor pembrolizumab (Keytruda) received regulatory approval for the treatment of adult and pediatric patients with unresectable or metastatic solid tumors that are MSI-H or mismatch repair deficient (dMMR). In September 2019, the FDA granted an accelerated approval to the combination of pembrolizumab and lenvatinib (Lenvima) for the treatment of patients with advanced endometrial cancer that is not MSI-H or dMMR.

Moving immunotherapy earlier in treatment followed by chemotherapy may improve response rates and prolong progression-free survival for patients with endometrial cancer, concludes Slomovitz.