Recent Advances in Treating Endometrial and Cervical Cancers

Expert gynecologic oncologists discuss recent progress in treating advanced endometrial and cervical cancers, including epidemiology, risk factors, evaluation, staging, and molecular testing.

Key opinion leaders review recent updates to the NCCN guidelines for treating recurrent and advanced endometrial cancer, including biomarker testing and targeted therapies like dostarlimab and trastuzumab.

The panel discusses factors to consider when determining best treatment options for patients with recurrent or advanced endometrial cancer, including traditional clinical trial endpoints, cost, chance for cure versus disease control, and most importantly, patient preference.

David M. O’Malley, MD, details the definition of dMMR (mismatch repair deficiency), its prevalence in advanced endometrial cancer, and current treatment approaches for dMMR patients, with a focus on the potential for cure in recurrent/metastatic dMMR patients based on clinical trial data.

Thomas C. Krivak, MD, shares the positive results from the RUBY trial of pembrolizumab plus chemotherapy followed by maintenance in patients with dMMR advanced endometrial cancer, supporting its approval and use in this population.

Dr Thomas C. Krivak highlights key data from the GY018 trial investigating chemotherapy plus pembrolizumab in both dMMR and pMMR advanced endometrial cancer, confirming and extending the findings from the RUBY trial supporting pembrolizumab's approval and use in both dMMR and pMMR populations.

The panel reviews results from the ATTEND and DUO-E trials in advanced endometrial cancer, suggesting pembrolizumab remains the standard for the dMMR patient subset while combinations with PARP inhibitors may improve outcomes in pMMR.

Key opinion leaders share excitement about antibody-drug conjugates targeting HER2 in advanced or recurrent endometrial cancer, and debate optimal HER2 testing methods, with some preferring gastric cancer scoring criteria over breast cancer criteria.

The panel highlights recent data on antibody drug conjugates targeting TROP2 in patients with advanced or recurrent endometrial cancer and the need for dose optimization.

Experts are enthusiastic about the potential of antibody drug conjugates to de-escalate therapy and reduce toxicity in advanced and recurrent endometrial cancer treatment, with a focus on the importance of diversity plans in clinical trials to ensure broader applicability.

David M. O’Malley, MD, discusses cervical cancer epidemiology, risk factors, and diagnosis, highlighting the importance of HPV vaccinations, regular PAP smears, and the use of various biomarkers for treatment decision making.

Leslie M. Randall, MD, reviews updates to the NCCN guidelines for cervical cancer, including the use of pembrolizumab in the second and third-line settings, the results of the KEYNOTE-826 trial, and the potential role of induction chemotherapy with weekly carboplatin and paclitaxel in the treatment of locally advanced cervical cancer.

Dana M. Chase, MD, FACOG, discusses the antibody-drug conjugate tisotumab vedotin including its mechanism of action, its accelerated approval for patients with recurrent cervical cancer and at least one prior line of therapy, and the management of toxicities such as neuropathy and pneumonitis.

Experts detail the management of ocular toxicity associated with tisotumab vedotin in patients with cervical cancer, emphasizing the need for eye care professionals and a team approach, along with addressing peripheral neuropathy.

Experts in gynecologic oncology discuss the positive results of TV-301, a confirmatory trial for TV-204, raising the possibility of moving tisotumab vedotin earlier in the treatment of patients with cervical cancer, and the potential to combine it with pembrolizumab.

Bradley Monk, MD, shares the promising potential of anti-HER2 therapy in cervical cancer and discusses encouraging results from recent trials, emphasizing the importance of testing for HER2 and considering anti-HER2 antibody drug conjugates as a treatment option.

The panel closes their discussion by highlighting challenges in the treatment of cervical cancer, emphasizing the need for more focus on clinical trials and therapies, as well as addressing disparities in cancer care, particularly for patients of color.