Sequencing ADCs in Endometrial Cancer

Sequencing therapy in recurrent endometrial cancer is becoming more complicated as immunotherapy moves earlier and antibody drug conjugates gain momentum. The faculty discuss why these agents are attractive after progression on frontline treatment, particularly because they may provide targeted delivery of potent cytotoxic therapy in a setting where options remain limited. At the same time, no clear algorithm exists for how best to position them in relation to chemotherapy, antiangiogenic therapy, or other later line approaches. Trastuzumab deruxtecan serves as an example of both promise and complexity, since its use requires careful counseling about nausea, cytopenias, fatigue, and pulmonary toxicity, along with close monitoring throughout treatment. The discussion emphasizes that sequencing decisions must take into account disease tempo, prior therapy, comorbidities, and the practical ability to manage adverse events. Rather than endorsing a rigid order of treatments, the faculty advocate for individualized planning that balances efficacy with tolerability in a rapidly changing clinical landscape.