Dr. Slomovitz on Sequencing Strategies for 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 for endometrial cancer.

Traditionally, chemotherapy and radiation therapy have always been the standard treatment options for patients with advanced or recurrent endometrial cancer, says Slomovitz. However, interesting results from the GOG-258 trial demonstrated that radiation therapy, in combination with chemotherapy, does not significantly improve survival. These data indicate that holding off on radiation therapy until salvage therapy is needed may serve as an alternative option, adds Slomovitz.

Furthermore, investigators recently discovered that, depending on the patient's genetic makeup and the classification of the tumor, immunotherapies are very active in endometrial cancer, explains Slomovitz. For example, pembrolizumab (Keytruda) has been approved for patients with microsatellite instability–high (MSI-H) endometrial cancer. Conversely, for patients who do not have MSI-H disease, the combination therapy of pembrolizumab and the TKI lenvatinib (Lenvima) is an approved option available for use in certain types of endometrial cancer, says Slomovitz.

Investigators understand that these agents are effective in the second-line setting; however, they are now analyzing whether immunotherapy could be moved to an earlier setting, followed by chemotherapy, could potentially result in better outcomes for patients. Determining the right sequence could help prolong survival for patients, concludes Slomovitz.