Updates on First-line and Subsequent Treatment Options for Advanced Endometrial Cancer - Episode 1
Vicky Makker, MD and Ramez Eskander, MD discuss the increasing global incidence of endometrial cancer.
Vicky Makker, MD: Hello everyone, and welcome to this OncLive® Insights program on endometrial cancer. I’m Vicky Makker and I’m a gynecologic medical oncologist from Memorial Sloan Kettering Cancer Center in New York, and I’m pleased to join you all today to discuss how we approach the care of patients with endometrial cancer. I’m thrilled to be joined today by my esteemed colleague, Dr Ramez Eskander, a gynecologic oncologist from the University of California, San Diego. With that background, we’re both looking forward to this so we’ll go ahead and get started.
Ramez Eskander, MD: Thank you, Dr Makker, for the kind introduction. It’s wonderful to be with you today. You’re clearly a leader in the field of therapeutics and identifying effective treatment strategies for a population of patients that for a long time we really didn’t have much to offer. Recently, with the publication of KEYNOTE-775, [we] have transformed how we think about use of lenvatinib and pembrolizumab in this patient population. Before we get there, given how dynamic the space is could you just take a moment and share with me what are your thoughts about where things stand right now. There was a recent publication that talked about how the mortality associated with endometrial cancer was now catching up to ovarian cancer in the GYN [gynecology] space. Where should we be going with this, and how does this impact the motivation to find effective treatment strategies?
Vicky Makker, MD: Absolutely Ramez, you’re right. This is really becoming a global problem, endometrial cancers, and I think, as you know, alarmingly the worldwide incidence of endometrial cancer, as well as the disease-associated mortality of this malignancy, are sharply on the rise. Maybe I’ll just talk about that for a minute. As you know, the incidence of endometrial cancer now is greater than 417,000 cases worldwide. Endometrial cancer is the sixth most common gynecologic malignancy. As we know, most cases occur between the ages of 65 and 75, though we are now seeing younger women with endometrial cancers in the setting of obesity which is very concerning. Endometrial cancer-associated mortality is also sharply and very concerningly rising by about 1.9% per year and this very worrisome trend is expected to continue well into the next 20 to 30 years. So I think this disease is going to become our no. 1 problem in the gynecologic oncology space.
We just got the 2022 estimates for endometrial cancer in the United States and now it topples greater than 65,900 cases with regards to incidents and as the estimated deaths are greater than 12,500. In fact, as you said, endometrial cancer and ovarian cancer now have equivalent estimated incidence of death, which is really gravely concerning. The problem is the needle up until recently really hasn’t moved forward with regards to therapeutics in the advanced recurrent endometrial cancer space, but now we have had really concerted interest in the development of therapeutics in that space. I think we’re really going to see a very nice change in the management certainly of upfront advanced endometrial cancers but also for specific molecular subtypes in the recurrent disease setting. I think what’s clear is that we know a lot about the molecular subtypes of endometrial cancers. We know a lot about the immunophenotypic profiles of endometrial cancers. But now clinical practice has to catch up. I think that’s really where the focus needs to be. This whole idea of 1 size fits all, certainly with chemotherapy in endometrial cancers, really is not a thought process that can be espoused to any longer.
Ramez Eskander, MD: I couldn’t agree more. I think one of the other things that to us is a relevant and important part of this is the disproportionate impact that the increase in mortality has on minority patients and what’s the relevance of that. We have lots of hypotheses about how we can explain this discrepancy but I’m not sure that we truly understand exactly what’s driving these differences aside from understanding a bit more about which histologies are impacting, for example, black patients more than they are white or non-Hispanic white patients.
Transcript edited for clarity.