Dr Pothuri on Real-World Treatment Patterns Per MMR/MSI Status in Endometrial Cancer

Bhavana Pothuri, MD, gynecologic oncologist, professor, Department of Obstetrics and Gynecology, New York University (NYU) School of Medicine, director, gynecologic oncology clinical trials, NYU Langone Health, discusses real-world treatment patterns and outcomes in patients with advanced endometrial cancer according to mismatch repair (MMR) and microsatellite instability (MSI) status.

A retrospective study using the nationwide Flatiron Health electronic health record-derived deidentified database identified and evaluated 1,441 patients diagnosed with advanced or recurrent endometrial cancer who initiated first-line therapy between January 1, 2018, and June 30, 2023. Patient characteristics, treatment patterns, and real-world time to next treatment were examined according to whether patients had mismatch repair–deficientdisease, mismatch repair–proficient disease, or were never tested, Pothuri details. 

Key findings presented at the 2024 ASCO Annual Meeting revealed that 83% of patients received MMR/MSI testing, with testing rates increasing over time, Pothuri reports. However, disparities were observed, with Black and Hispanic patients being less likely to undergo testing, she notes. Additionally, 55% of patients received HER2 testing, an emerging biomarker in endometrial cancer treatment, Pothuri states. This suggests that systemic barriers to testing still need to be addressed to improve treatment outcomes in these populations, she explains.

Moreover, despite the prevalence of MMR/MSI testing, the utilization of second-line immunotherapy for dMMR disease and a checkpoint inhibitor plus VEGF inhibitor for pMMR endometrial cancer was lower than expected, Pothuri continues. This indicates a slow uptake of recently approved therapies. Furthermore, the slow uptake of new therapies underscores the necessity for continued education and system-level changes to expedite the adoption of molecular profile-specific treatments, she emphasizes.

Overall, the study highlights the need to address MMR/MSI testing gaps, particularly among underrepresented patients, to ensure equitable access to new therapies.