Managing Progression After Immunotherapy in Endometrial Cancer

Management after progression on immunotherapy remains one of the most difficult areas in endometrial cancer care. Faculty describe how treatment decisions differ for patients with indolent low volume recurrence compared with those who present with symptomatic or bulky progression, and they stress that clinical context should guide the next step in care. For some patients, the discussion includes whether adding another systemic agent is reasonable, while for others a clear change in treatment strategy is necessary. HER2 expressing disease receives focused attention because trastuzumab deruxtecan may offer meaningful activity in selected patients, although important questions remain about durability, confirmatory evidence, and optimal sequencing. The panel also emphasizes the need to weigh efficacy against toxicity, especially pulmonary risk, cytopenias, and gastrointestinal adverse events. The result is a practical discussion that reflects the uncertainty many clinicians face when disease progresses after frontline immunotherapy and highlights how urgently more evidence is needed in this setting.