Gynecologic Oncology

Looking ahead, Floor Backes, MD, notes that key needs in the treatment of advanced endometrial cancer are figuring out next steps when immunotherapy resistance develops, targeted radiation for oligometastatic disease, and sorting patients into subgroups for personalize care.

The 2023 ESMO Congress took place October 20 to 24 in Madrid, Spain, with global perspectives on groundbreaking data. We break down some of the key highlights from the annual meeting that oncology fellows should absorb, and apply to practice, as soon as possible.

In a full-circle scenario, Cedars-Sinai Cancer, based in Los Angeles, California, welcomed back Margaret Liang, MD, MSHPM, in July 2023 to the institution where she completed her fellowship.

Michael P. Stany, MD, discusses the optimization of PARP inhibitors in the upfront maintenance setting of ovarian cancer, the benefit of novel targets and immunotherapy combinations, and the role of immunotherapy in the treatment of advanced endometrial cancer.

The FDA has granted breakthrough therapy designation to the HER2-targeted antibody-drug conjugate BNT323/DB-1303 for use as a potential therapeutic option in patients with advanced endometrial cancer who have progressed on or after treatment with immune checkpoint inhibitors.

Dostarlimab plus carboplatin and paclitaxel, followed by maintenance dostarlimab and niraparib, significantly improved PFS vs placebo plus chemotherapy followed by placebo in patients with primary advanced or recurrent endometrial cancer, according to data from the phase 3 RUBY trial.

Experts are enthusiastic about the potential of antibody drug conjugates to de-escalate therapy and reduce toxicity in advanced and recurrent endometrial cancer treatment, with a focus on the importance of diversity plans in clinical trials to ensure broader applicability.

The panel highlights recent data on antibody drug conjugates targeting TROP2 in patients with advanced or recurrent endometrial cancer and the need for dose optimization.

Hope Cottrill, MD, highlights practice-changing developments in endometrial cancer care, the benefits of local control with radiation in patients with locally aggressive disease, and questions that remain regarding treatment sequencing with immunotherapy.

Floor Backes, MD, and Matthew Powell, MD, review data on sacituzumab govitecan, an antibody-drug conjugate targeting topoisomerase in patients with advanced endometrial cancer.

Drs Backes and Powell discuss the management of adverse events between upfront immunotherapy versus chemotherapy followed by later immunotherapy for endometrial cancer, noting the need for molecular subgroup data from trials like LEAP-001.

The combination of pembrolizumab and lenvatinib failed to produce a statistically significant improvement in progression-free survival and overall survival vs platinum-based chemotherapy with carboplatin and paclitaxel as frontline therapy in patients with advanced or recurrent endometrial cancer whose disease in mismatch repair proficient/not microsatellite instability–high or mismatch repair deficient.

The European Commission has granted marketing authorization to dostarlimab paired with carboplatin and paclitaxel in adults with dMMR/MSI-H primary advanced or recurrent endometrial cancer who are eligible to receive systemic treatment.

Key opinion leaders share excitement about antibody-drug conjugates targeting HER2 in advanced or recurrent endometrial cancer, and debate optimal HER2 testing methods, with some preferring gastric cancer scoring criteria over breast cancer criteria.

The panel reviews results from the ATTEND and DUO-E trials in advanced endometrial cancer, suggesting pembrolizumab remains the standard for the dMMR patient subset while combinations with PARP inhibitors may improve outcomes in pMMR.

Matthew Powell, MD, and Floor Backes, MD, discuss real-world evidence from recent trials confirming benefit of immunotherapies in practice for patients with advanced endometrial cancer.

Drs Powell and Backes discuss additional immunotherapy trial results from ESMO 2023 including AtTEnd and DUO-E, noting differences across trials likely due to patient population composition rather than drug differences, and need for caution with PARP inhibitor maintenance.

Dr Thomas C. Krivak highlights key data from the GY018 trial investigating chemotherapy plus pembrolizumab in both dMMR and pMMR advanced endometrial cancer, confirming and extending the findings from the RUBY trial supporting pembrolizumab's approval and use in both dMMR and pMMR populations.

Thomas C. Krivak, MD, shares the positive results from the RUBY trial of pembrolizumab plus chemotherapy followed by maintenance in patients with dMMR advanced endometrial cancer, supporting its approval and use in this population.

Matthew Powell, MD, and Floor Backes, MD, enthusiastically discuss the practice-changing RUBY trial results presented at the 2023 ESMO Congress showing impressive survival benefits with immunotherapy plus chemotherapy for both MMR-deficient and MMR-proficient advanced endometrial cancer.

Experts Ritu Salani, MD, MBA, and Bhavana Pothuri, MD, explore the significance of enrolling diverse patients in clinical trials and the pivotal role of community settings in advancing endometrial cancer research and treatment.

Experts review data on single-agent immunotherapy in patients with endometrial cancer from recent conferences, including ASCO 2023.

Delve into the exciting developments in endometrial cancer treatment, including HER2 antibody drug conjugates, checkpoint inhibitors, and the promising impact of these therapies in the quest to reduce chemotherapy use.

Neoadjuvant chemotherapy preceding surgery did not result in a significant difference in 5-year overall survival rates compared with concomitant chemoradiotherapy in patients with stage IB2 to IIB cervical carcinoma, according to findings from the phase 3 EORTC-55994 trial.

David M. O’Malley, MD, details the definition of dMMR (mismatch repair deficiency), its prevalence in advanced endometrial cancer, and current treatment approaches for dMMR patients, with a focus on the potential for cure in recurrent/metastatic dMMR patients based on clinical trial data.