Endometrial Cancer&nbsp;&nbsp;&nbsp;

How would you manage a POLE mutated, p53 abnormal IA myoinvasive carcinosarcoma of the endometrium with no LVSI?

Do you offer observation for POLE mutated tumors?

Would you add olaparib to maintenance immunotherapy for a patient with recurrent MMR-proficient, HER2-negative serous endometrial carcinoma?

Given the negative results of GOG-0238 but the positive results of the RUBY trial, how do you manage isolated vaginal cuff recurrence of endometrial cancer?

Would you consider the addition of carboplatin/paclitaxel + dostarlimab to radiation as opposed to radiation alone?

What are your top takeaways from SGO 2022?

10 Answers available

What do you view as the future role for the combination of durvalumab + olaparib + chemotherapy in the management of patients with advanced/recurrent endometrial cancer following the DUO-E trial results?

Are there certain patient subgroups for whom you would use the IO+PARPi? Is there data from DUO-E regarding BRCA status and its potential impact on ...

In light of the improved outcomes seen in patients receiving IO +/- olaparib, what role, if any, do you think pelvic radiation still plays in the management of patients with advanced endometrial cancer?

Would you consider offering immunotherapy +/- olaparib to a patient with early-stage endometrial carcinoma for whom you are recommending adjuvant chemotherapy based on improved outcomes seen in RUBY/DUO-E/NRG-GY018?

If yes, would you apply this broadly or reserve the addition of IO to chemotherapy for patients with high-risk histologies (e.g., carcinosarcoma) or o...

In a patient with HER2+ advanced endometrial cancer, do you include IO(+/- olaparib) in their treatment regimen, or only trastuzumab in addition to carboplatin/paclitaxel?

Does your decision depend on MMR status? Would you use the same approach for neoadjuvant treatment?In light of relevant trials including RUBY, GY018, ...

Would you recommend adjuvant chemo+IO +/- olaparib for patients with occult stage III disease identified after staging surgery with no measurable residual disease?

DUO-E, GY-018, and RUBY included patients with stage III and IV endometrial cancer WITH measurable disease.Would your decision change based on the mis...

For patients with advanced endometrial cancer, are the improved outcomes in PFS from DUO-E/RUBY/NRG-GY018 sufficient to move immunotherapy to the frontline for all presuming FDA approval?

Are there patients for whom you would still reserve IO for salvage/recurrent setting (eg IO + lenvatinib)? Would you base this on MMR status or other ...

Do you follow GOG, ASTRO, or PORTEC recommendations for adjuvant therapy in stage I endometrial cancer patients?

What would you recommend for a patient in their 60s with stage IB grade 1 endometrial cancer without LVSI? How would this differ for a patient with st...

6 Answers available

Despite the paucity of strong data showing benefit of chemotherapy + radiotherapy in patients with stage I-II high risk histology endometrial cancer, if you recommend treatment with both modalities, how do you determine treatment schedule?

Do you proceed with sequential, concurrent, or sandwich treatment?

What are your top takeaways from SGO 2023?

7 Answers available

When do you expect the 2023 FIGO staging for endometrial cancer to become adopted clinically in the US?

How will you translate treatment recommendations from older studies to the new staging system?

In patients with advanced endometrial cancer who you plan to treat with chemotherapy + immunotherapy (per GY018 or RUBY), how and when do you utilize adjuvant EBRT and/or brachytherapy?

Does the presence of parametrial or cervical involvement impact your decision? How do you sequence treatment modalities?

How would you manage a Stage IB endometrioid endometrial cancer, status post staging surgery, with a rapid vaginal recurrence <1 month post operatively?

This case involves an impressive ‘high volume’ vaginal recurrence and patient was not originally planned for adjuvant therapy. Concerned t...

Would you recommend adjuvant chemotherapy to a patient who has stage IB grade 1 endometrioid endometrial cancer with isolated tumor cells in two pelvic lymph nodes and extensive LVSI?

How should molecular studies, in particular the presence of POLE or p53 mutations, be incorporated into the decision to treat an "intermediate risk" endometrial cancer patient with adjuvant therapy after hysterectomy?

Considering the ASTRO guidelines recommend against systemic therapy for patients with FIGO stage I-II endometrioid adenocarcinoma, would your recommen...

6 Answers available

What are your top takeaways in Gynecologic Cancers from ASCO 2023?

Given patients with substantial LVSI experience a pelvic recurrence rate of ~25%, how do you counsel patients with stage IA endometrioid endometrial cancer with LVSI regarding the relative risks/benefits of EBRT versus VBT alone?

Please comment on toxicity profiles and the insufficient evidence regarding overall survival.

5 Answers available

What is your preferred first line systemic treatment for recurrent, metastatic, low grade, ER/PR+ pMMR endometrioid endometrial carcinoma?

Would you consider chemoradiation + chemotherapy as in PORTEC-3 regimen for p53 mutated stage IA endometrial cancer, though this trial did not include those with stage IA disease?

If you do not use the PORTEC-3 regimen for p53 mutated IA endometrial cancer, what specific protocol or combination of chemotherapy and radiation ther...

5 Answers available

What is your approach to the adjuvant treatment of early-stage mixed-histology endometrial cancer with a significant clear-cell component?

How do you take into account pathologic factors like %clear cell histology, myometrial invasion, and LVSI?

How would you treat a recurrent endometrial cancer at the vaginal cuff that was initially FIGO 1A with no adj treatment, in a patient with actively treated scleroderma?

What is your approach to the adjuvant treatment for stage IA grade 2 endometrioid adenocarcinoma without LVSI whose molecular classification is p53 abnormal (MMR intact, POLE wild type)?

How does your approach differ for patients under age 60, between 60-70, and over age 70?

How would you treat an isolated para-aortic lymph node endometrial cancer recurrence following a prolonged disease free interval previously treated with surgery, chemotherapy, and radiation therapy, if it is located outside of the previously irradiated field?

How does histology and/or molecular testing change your approach? How does the length of the disease free interval change your approach?

How do you approach systemic treatment for endometrial endometrioid adenocarcinoma with neuroendocrine differentiation?

In what situations would you use a neuroendocrine chemotherapy regimen over carboplatin+paclitaxel?

Do you offer patients with advanced endometrial cancer lower starting doses of lenvatinib when used in combination with pembrolizumab given high adverse event rates with 20 mg daily?

Is there a role for using pembrolizumab alone in microsatellite stable endometrial cancer if patients are unable to tolerate lenvatinib?

What are real world exclusion criteria for the use of lenvatinib + pembrolizumab for advanced endometrial cancer?

Are there specific clinical or social scenarios that would preclude the use of this treatment?

Is there a difference in survival or disease response between patients with recurrence free interval ≥1 vs <1 year from platinum-based cytotoxic therapy who are treated with pembrolizumab + lenvatinib?

In the KEYNOTE-775 study, what was the proportion of patients who had a recurrence free interval ≥1 year from platinum-based cytotoxic chemotherapy...

Are there any data that suggest superiority of lenvatinib + pembrolizumab vs platinum-based cytotoxic chemotherapy for advanced or recurrent endometrial cancer?

Are there any planned trials to compare lenvatinib + pembrolizumab and platinum-based cytotoxic chemotherapy for advanced or recurrent endometrial can...

How do you approach adjuvant chemotherapy for high risk/advanced endometrial cancer patients?

Does your approach to the number of cycles vary based on plan to include radiation therapy or presence of certain histopathologic features?

Is there a difference in the incidence of serious immune-related adverse events with the lenvatinib + pembrolizumab combination vs pembrolizumab alone in endometrial cancer?

Anecdotally, I have seen more serious IRAEs in patients I'm treating with this regimen than anticipated. Is there higher risk with this drug combinati...

How would you manage a bulky, locally advanced endometrial cancer with extensive parametrial involvement in a patient inoperable due to medical comorbidities?

When, if ever, would you consider lenvatinib + pembrolizumab as first line therapy for patients with stage IV microsatellite stable endometrial cancer?

Are there certain patient or disease related factors that would lead you to incorporate lenvatinib + pembrolizumab earlier?

What is optimal therapy for a 5 year delayed recurrence of uterine cancer, rendered NED by solitary pulmonary metastasis resection?

And if the tumor is MSI-H, does that alter your thoughts?

Do you routinely check tumor genomics, including POLE status for new endometrial cancers?

How does the presence of specific mutations affect your adjuvant treatment planning or patient counseling? Given POLE mutation status can currently o...

If a patient with HER2+ uterine serous carcinoma recurs while on maintenance trastuzumab, would you continue trastuzumab with second line chemotherapy?

Given data from metastatic breast cancer trials that show benefit with continuing trastuzumab despite progression.

In patients with recurrent MSI-H endometrial cancer on immunotherapy with pembrolizumab, when do you discontinue therapy?

Do you stop therapy at 2 years or continue until progression of disease?

What is your adjuvant therapy for node positive, low grade endometrioid endometrial adenocarcinoma?

Do you treat an endometrial cancer that is microsatellite-stable but has a high TMB after progressing on platinum-based therapy with pembrolizumab?

Do you recommend adjuvant treatment for nodal isolated tumor cells in an otherwise low-risk endometrial cancer?

If a patient with recurrent endometrial cancer experiences minimal or slow disease progression on pembrolizumab or pembro/lenvatinib, would you consider continuing or would you change agents?

Patient has tolerated combination therapy well to date.

How does positive p53 staining influence your recommendation for adjuvant therapy in comprehensively staged early (stage IA or IB), grade 2, endometrioid endometrial cancers?

If patient meets high intermediate risk criteria, would you consider chemotherapy in addition to radiation?

Would the presence of multifocal LVSI change your adjuvant treatment recommendation for a surgically staged IA dedifferentiated endometrial carcinoma?

Does not technically meet high intermediate risk criteria.

Would development of a rectovaginal fistula mid-treatment with second line pembrolizumab/lenvatinib for endometrial cancer cause you to change regimens, eliminate lenvatinib, or continue current therapy?

The patient has a history of pelvic radiation and progressed through first line carboplatin/taxol. She has had a partial response to pembro/lenvatinib...

How do you sequence chemotherapy with radiotherapy for advanced endometrial cancer?

What adjuvant therapy would you offer a patient with Stage II uterine serous carcinoma without lymph node sampling?

Would you offer adjuvant therapy following successful resection of a solitary lung recurrence of leiomyosarcoma if no other evidence of recurrent disease on PET CT?

What starting dose of lenvatinib are you ultilizing in recurrent endometrial cancer patients initiating lenvatinib/pembro?

Would you recommend systemic therapy in a patient with a history of Stage III high grade serous endometrial cancer s/p resection of a solitary pulmonary metastasis after a long disease free interval?

Does residual grade 1-2 neuropathy from Taxol/ carbo 10 years ago affect your recommendation?

Do you recommend concurrent chemotherapy with XRT for inoperable patients with stage I-II high-risk endometrial carcinoma?

Ie for patients who are inoperable due to comorbidities?

Would you recommend maintenance therapy with a PARP inhibitor for BRCA+ patients with advanced uterine serous cancer?

Since no data exists or is pending, and the two disease processes are similar, should we consider PARP inhibition in this setting? This is assumi...

In a patient metastatic recurrent endometrioid endometrial cancer who has a mixed response to carboplatin and paclitaxel, what is your next choice of therapy?

No adjuvant treatment was given upfront

How do you decide on adjuvant therapy in a patient with a Stage IA uterine carcinosarcoma without any myometrial invasion?

The NCCN recommends either systemic therapy + brachytherapy or pelvic RT + brachy or brachy alone or observation. How do you decide among these option...

Do you recommend stopping olaratumab in patients receiving doxorubicin/olaratumab for treatment of advanced sarcoma?

Given the recent press release regarding the update on the phase 3 soft tissue sarcoma study of LARTRUVO (olaratumab) showing no benefit to the combin...

For a patient with carcinosarcoma of the uterus and an allergic reaction to paclitaxel, would you have any reservations about using docetaxel instead?

How would you manage a patient with low-volume non-invasive endometrioid carcinoma that is found in both the endometrium and ovary (pN0)?

Would you approach this situation as synchronous primaries (eg. FIGO IA in both) or as a locally advanced endometrial cancer (FIGO IIIA)? What adjuva...