Highlights on Endometrial Cancer (SGO)

Prof Jean-François Baurain,  professor of medical oncology at Cliniques Universitaires Saint-Luc, UCLouvain, presents key updates from the SGO meeting in San Diego focusing on advancements in the treatment landscape for endometrial cancer.

Notable progress has been made in the treatment of endometrial cancer, particularly in patients with mismatch repair deficiency (dMMR) or microsatellite instability-high (MSI-H) tumours. Checkpoint inhibitors have demonstrated significant improvements in overall survival across trials such as RUBY, NRG, and DUO-E.

For proficient mismatch repair (pMMR) patients, investigations into adding immune checkpoint inhibitors to chemotherapy have shown some benefit in terms of progression-free survival, albeit not as pronounced as in dMMR patients. The addition of PARP inhibitors like olaparib to chemotherapy and durvalumab has shown promise in improving progression-free survival and quality of response in pMMR patients.

Prof  Baurin also discusses ongoing trials exploring various treatment combinations, including selexinor for p53 normal patients and trastuzumab-deruxtecan for HER2-positive patients. For MSI patients, trials such as DOMENICA and KEYNOTE-158 are evaluating the possibility of replacing chemotherapy with checkpoint inhibitors.

At the SGO meeting, the LEAP-0001 trial compared chemotherapy with pembrolizumab and lenvantinib, although it failed as a superiority trial, further data analysis may reveal positive signals in terms of progression-free survival.

In the early-stage setting, questions remain regarding the addition of chemotherapy to radiotherapy. While PORTEC-3 trials aimed to address this, new data from the GOG team suggest similar benefits between radiochemotherapy and radiotherapy alone, with potential benefits observed in patients with P53 wild-type status. However, complexities in biomarker staging and incomplete evaluation of clinical lymph node invasion status in trials like PORTEC3 pose challenges in accurately assessing patient outcomes and may necessitate revisions to current staging criteria.

In conclusion, ongoing research and refinement of treatment strategies, including thorough lymph node assessment and sentinel lymph node biopsy in all endometrial cancers, are crucial for improving outcomes and tailoring treatment approaches for patients with endometrial cancer.