Dr Wagar on the Evolution of Advanced/Recurrent Endometrial Cancer Management

"In the past couple of years, the management of advanced/recurrent endometrial cancer has changed dramatically. We have seen an integration of immunotherapy with chemotherapy, as well as new ADCs that have found a home and have thrived for some of our patients with endometrial cancer."

Matthew Wagar, MD, a gynecologic oncology fellow in the Department of Obstetrics and Gynecology at the University of Wisconsin School of Medicine and Public Health, discusses the evolving management of advanced and recurrent endometrial cancer.

The management of advanced or recurrent endometrial cancer has evolved significantly in recent years, with the integration of immunotherapy into chemotherapy-based regimens and the emergence of ADCs as viable treatment options, Wagar begins. During a recent OncLive® State of the Science Summit™ on gynecologic cancers, Wagar and colleagues reviewed 2 case studies that were emblematic of these advancements.

The first case focused on the incorporation of immunotherapy with chemotherapy in a patient with recurrent endometrial cancer who had not previously received chemotherapy, Wagar details. The discussion included an evaluation of eligibility criteria and the clinical data supporting the use of carboplatin plus paclitaxel in patients with this disease, he recounts. Historically, this regimen was the standard of care; however, the publications of the phase 3 NRG-GY018 (NCT03914612) and RUBY (NCT03981796) trials led to a paradigm shift, he says. These studies demonstrated the efficacy of adding immunotherapy—pembrolizumab (Keytruda) in NRG-GY018 and dostarlimab-gxly (Jemperli) in RUBY—to chemotherapy in patients with advanced or recurrent disease. Key considerations for integrating these agents—including patient selection, adverse effect monitoring, and optimal sequencing—were also discussed at the meeting, he adds.

The second case highlighted the role of fam-trastuzumab deruxtecan-nxki (Enhertu; T-DXd) in endometrial cancer, Wagar continues.

As immunotherapies continue to gain traction in the endometrial cancer treatment paradigm, their efficacy and safety profiles are being further explored, he says. Overall, these discussions underscored the rapid advancements in endometrial cancer management and the importance of personalized approaches in optimizing patient outcomes, he concludes.