Role of Molecular Testing in Stage 1B, Grade 3 Endometrial Cancer

David Barrington, MD, obstetrics & gynecology specialist at Ohio State University Comprehensive Cancer Center, discusses his advice on molecular testing for patients with stage 1B, grade 3 endometrial cancer.

There are a variety of adjuvant treatment options available for this patient population, including external beam radiation, and adjuvant chemotherapy, and more. Still, the standard of care for treating these patients remains unknown, and researchers are excited to look more into the molecular characteristics of tumors in these patients.

Examining the molecular characteristics will aid in learning more about mismatch repair protein status, protein deficiencies, immunotherapy with radiation, and more. Barrington hopes that emerging clinical and preclinical data will show the relation between immunotherapy checkpoint inhibitors and radiation in order to further change the landscape for these early stage cancers.

Transcription:

0:08 | At Ohio State, we do universal immunohistochemistry for all endometrial cancers. That gives us an immediate idea, if we see mismatch repair protein deficiency, that helps us guide clinical trial recommendations. Then, it also can help manage decisions for optimal management for treatment, a recurrent setting. Then sometimes there's emerging data that tumors with p53 mutations may exhibit a more aggressive behavior. That's something we're learning more and more about and some are incorporating those molecular characteristics into their treatments or application of their trials.

1:03 | Sometimes, these grade 3 tumors are difficult to differentiate from other high grade in vitro histologies, like urine serous cancers, and sometimes p53 will be tested to help aid in diagnosis. We also know that even when the diagnosis is confirmed as grade 3, some of those patients are going to have p53 mutations as well. It's hard to say what actual clinical information we have and that we can then incorporate for the adjuvant treatment setting up upfront, but it is something that I think we're going to continue to learn more about.

1:39 | I think an important point is that we aren't routinely doing polymerase epsilon testing, but we can often see p53 mutations when the tumor does have POLE mutations, and that can be difficult to interpret as well. We also have emerging data to show that POLE mutations have a better prognosis if a p53 mutation, which can sometimes lead to worse prognosis arises because the POLE mutation can be difficult to interpret. Those tests, in an ideal setting when incorporated into clinical practice, would be done in concert with one another.