Roundtable Roundup: Surveying Oncologists on Endometrial Cancer Treatment

In separate virtual live events, Bhavana Pothuri, MD, and Krishnansu S. Tewari, MD, discussed the treatment options of a patient with advanced endometrial cancer and participants chose an immune checkpoint inhibitor to use for therapy.

CASE SUMMARY

In August 2021, a 64-year-old postmenopausal woman presented to her gynecologist with abnormal uterine bleeding lasting 4 months. She underwent menopause at 55 years of age. She is a widow, has no children, and lives alone. She has a medical history of gravida 1, para 0; arthritis; obesity (body mass index = 40); and hypertension well controlled with once-daily angiotensin-converting enzyme inhibition. Her 2020 Papanicolaou test was negative, and ECOG performance status was 1.

She was counseled on surgical options, then scheduled accordingly. She had stage IA, grade 1 endometrial cancer. Immunohistochemistry/molecular testing results showed a mismatch repair deficiency and microsatellite instability–high status, and 3+ estrogen receptor–positive disease.

In August 2022, she reported intermittent pelvic pain over prior 4 weeks. CT scan of the chest, abdomen, and pelvis (CAP) suggested relapsed/metastatic disease with involvement of 1 right external iliac lymph node. Carboplatin/paclitaxel (6 cycles every 4 weeks) was administered, chemotherapy was well tolerated, and a complete response was recorded at end of regimen.

In April 2023, disease relapse was documented on routine follow-up. CT CAP scan showed heterogeneously enhancing mass in right suprarenal space, multiple bilateral pulmonary nodules, and a new right internal iliac lymph node (in addition to the previously observed positive lymph node).

Fine-needle aspiration of the suprarenal mass confirmed metastatic endometrioid adenocarcinoma. The patient was counseled about systemic therapy options, during which she repeatedly expressed concerns about adverse events. Through shared decision-making, immune checkpoint inhibitor monotherapy was planned.

_REFERENCE

_{1. NCCN. Clinical Practice Guidelines in Oncology. Uterine neoplasms, version 1.2024. Accessed February 2, 2024. http://tinyurl.com/28y356bt}