Overcoming Barriers: Empowering Underrepresented Groups With Endometrial Cancer

Overcoming Barriers: Empowering Underrepresented Groups with Endometrial Cancer from Patient Empowerment Network on Vimeo.

 How can endometrial cancer care barriers be overcome for underrepresented groups? Expert Dr. Emily Hinchcliff from Northwestern Medicine discusses racial and cultural barriers and advice to patients to be proactive toward receiving optimal care.

[ACT]IVATION TIP

“…know the genetic status of your tumor, specifically something called the mismatch repair status of your tumor. And then not only how does that status impact your own treatment, but also how that may impact your family members…understand what resources are out there for you as a patient, especially for women in underserved groups and minority populations.”

See More from [ACT]IVATED Endometrial Cancer

Related Resources:

Overcoming Geographical Barriers in Endometrial Cancer Care

Overcoming Geographical Barriers in Endometrial Cancer Care

Innovative Approaches to Endometrial Cancer Care in Underrepresented Communities

Innovative Approaches to Endometrial Cancer Care in Underrepresented Communities

Endometrial Cancer Care Disparities | The Impact of Rural Residence

Endometrial Cancer Care Disparities: The Impact of Rural Residence

Transcript:

Lisa:

Dr. Hinchcliff, in your research, you dive deeply into the significant disparities that exist within medically underserved and minority populations in the U.S. when it comes to awareness of, access to, and the use of genetic services in endometrial cancer. Can you speak to the research and provide tips to these patients and families?

Dr. Emily Hinchcliff: 

Yeah, so I think that there are sort of two different pieces that go on here. First is the relationship of endometrial cancer, that some of it can be, I guess, at random, and some of it can be genetic. So understanding, especially for those who have a strong family history, that there are hereditary forms of endometrial cancer. I think that’s a really important point for patients to take away. And then we, as a society, as a field, now recommend kind of routine screening for those tests to determine, Is an endometrial cancer hereditary or not? So make sure that you, as a patient, know your results and know if your family members should be tested in any way.

The second is regarding the significant disparities that exist. We know, as a field, as a kind of medical subspecialty, that there is a racial disparity in endometrial cancer mortality. While there is a lot of research going on to address the kind of potential biologic component there, is there something different about the cancers that are developed in different racial groups? I think there’s also really important research going on about the kind of systemic and cultural barriers and differences that women of different races experience that also can dramatically impact their cancer care.

Lisa:

And do you have an activation tip for this question?

Dr. Emily Hinchcliff:  

I’ll give you two different activation tips. I think that the first is to know the genetic status of your tumor, specifically something called the mismatch repair status of your tumor. And then not only how does that status impact your own treatment, but also how that may impact your family members. And then I think the second is to understand what resources are out there for you as a patient, especially for women in underserved groups and minority populations. Simply obtaining support can often be a really important key first step to gaining access and understanding of your disease.


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Innovative Approaches to Endometrial Cancer Care in Underrepresented Communities

Innovative Approaches to Endometrial Cancer Care in Underrepresented Communities from Patient Empowerment Network on Vimeo.

How can endometrial cancer care use innovative approaches in underrepresented communities? Expert Dr. Emily Hinchcliff from Northwestern Medicine discusses diagnostic testing tools and support in navigating clinical trials.

[ACT]IVATION TIP

“… doing your own research and your own reading is really important, being your own advocate. But I think that your physician can serve as an excellent, almost medical translator to understand what is right for you and which of the many, many novel things that we are discovering every day is applicable to you and which might be good for you and which don’t actually apply or which are not potentially your best option in that side.”

See More from [ACT]IVATED Endometrial Cancer

Related Resources:

Overcoming Geographical Barriers in Endometrial Cancer Care

Overcoming Geographical Barriers in Endometrial Cancer Care

Overcoming Barriers: Empowering Underrepresented Groups With Endometrial Cancer

Overcoming Barriers: Empowering Underrepresented Groups With Endometrial Cancer

Endometrial Cancer Care Disparities | The Impact of Rural Residence

Endometrial Cancer Care Disparities: The Impact of Rural Residence

Transcript:

Lisa:

Dr. Hinchcliff, are there any innovative approaches or technologies that you and your team are exploring to improve endometrial detection, treatment, or support services, especially for your underrepresented communities with limited access to healthcare resources?

Dr. Emily Hinchcliff:  

Yeah, so there are many, many different things that we’re doing here that we’re very excited about. I think I’ll probably highlight two. So one of the ones that I have been working on closely is there is an ever-increasing number of diagnostic testing tools that we have within our kind of armamentarium. And so one particular test that patients may have read about or heard about is something called circulating tumor DNA. And this is a pretty novel test that I will be completely open and honest that we don’t totally know how to use or how to incorporate in our cancer surveillance, meaning so once someone is diagnosed,  is this a test that can help us to watch to see if treatments are working or watch to see if a cancer may have come back? Similarly, can it be used as a screening tool? We just don’t know that, and so that’s an area that I am actively working in.

The other thing that one of my colleagues here is working on is trying to really create access for women who have limited access to healthcare. So we have developed a clinical trial platform to allow the women, specifically of Chicago, to better understand their options for clinical trials across the institutions in Chicago. So we have at Northwestern multiple cutting-edge endometrial cancer trials trying to bring these novel therapeutics to the forefront and to patients and also to thoughtfully triage patients to kind of treatments that we think are going to maximize their effectiveness and minimize toxicity.

But similar to us, the other institutions around Chicago have a different panel of clinical trials. And so for patients, it can be really overwhelming to know which trial, which institution, how do I know, how do I access all of that? And so we’re working to create a platform for patients and to have clinical navigators associated to help them to understand their options.

Lisa:

And do you have an activation tip?

Dr. Emily Hinchcliff:  

So I think that when patients are thinking about innovation and how can they make sure that they are at the cutting edge, I think that your physician is really your access point. So obviously, doing your own research and your own reading is really important, being your own advocate. But I think that your physician can serve as an excellent, almost medical translator to understand what is right for you and which of the many, many novel things that we are discovering every day is applicable to you and which might be good for you and which don’t actually apply or which are not potentially your best option in that side.


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Overcoming Geographical Barriers in Endometrial Cancer Care

Overcoming Geographical Barriers in Endometrial Cancer Care from Patient Empowerment Network on Vimeo.

How can endometrial cancer care barriers be overcome in regards to geographic location? Expert Dr. Emily Hinchcliff from Northwestern Medicine discusses geographic care barriers, solutions, and patient advice to be proactive in their care.

[ACT]IVATION TIP

“…understanding that post-menopausal bleeding is never normal and that you need to see a physician for that…regarding the fact that accessing care can be, as you mentioned, done in many, many different ways these days. And so understanding what your options are, whether that’s telehealth, whether that’s a consult visit and then receiving the majority of the subsequent care closer to home, you have a lot of options.”

See More from [ACT]IVATED Endometrial Cancer

Related Resources:

Which Endometrial Cancer Clinical Trials Are Showing Promise

Which Endometrial Cancer Clinical Trials Are Showing Promise?

Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality

Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality

Endometrial Cancer Care Disparities | The Impact of Rural Residence

Endometrial Cancer Care Disparities: The Impact of Rural Residence

Transcript:

Lisa:

If a woman goes in and is diagnosed at her local cancer center and has endometrial cancer, should she see some type of subspecialist, would it be of benefit to that patient maybe to even do a consult, a telemedicine consult at least upon diagnosis? Or how can a person who is more remote geographically access a subspecialist care or expertise?

Dr. Emily Hinchcliff: 

Yeah, absolutely. So I think that telehealth has really changed medicine in general and provides some really great opportunities for access. There is a big kind of dichotomy in endometrial cancer where early stage disease is often caught because it has a symptom, vaginal bleeding is a symptom. And so early stage disease can often be treated with surgery alone.

And so that surgical management, again, can potentially be done by a GYN oncologist at a one single time point. The subsequent care, so I’ll just use myself as an example. I will often see women for sort of that initial visit, treatment decision, sometimes surgery, but then if they need additional adjuvant therapy, such as chemotherapy, they’ll go closer to home to receive some of those therapies. And then I will serve as a bit of a consultant to their providers closer to home to discuss what treatment options, what regimens and how to manage toxicities might be good in their case.

Lisa:

And do you have an activation tip for patients for that question?

Dr. Emily Hinchcliff:  

Yeah, so I think that my activation tip here regarding barriers to endometrial cancer care is first and foremost addressing the knowledge gap, understanding that post-menopausal bleeding is never normal and that you need to see a physician for that, I think is the first key tip. The second tip, I guess, if I could give a second activation tip, is regarding the fact that accessing care can be, as you mentioned, done in many, many different ways these days. And so understanding what your options are, whether that’s telehealth, whether that’s a consult visit and then receiving the majority of the subsequent care closer to home, you have a lot of options. And we as a field in GYN oncology are really collaborative. And I think most of us would feel very positively towards creating a team to help you get the care you need.


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Endometrial Cancer Care Disparities: The Impact of Rural Residence

Endometrial Cancer Care Disparities: The Impact of Rural Residence from Patient Empowerment Network on Vimeo.

What kind of care disparities do endometrial cancer patients from rural areas face? Expert Dr. Emily Hinchcliff from Northwestern Medicine shares her perspective on obstacles for patient care in rural areas and patient advice to help ensure optimal care.

See More from [ACT]IVATED Endometrial Cancer

Related Resources:

Which Endometrial Cancer Clinical Trials Are Showing Promise

Which Endometrial Cancer Clinical Trials Are Showing Promise?

Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality

Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality

Overcoming Geographical Barriers in Endometrial Cancer Care

Overcoming Geographical Barriers in Endometrial Cancer Care

Transcript:

Lisa:

Dr. Hinchcliff, can you speak to barriers faced by rural endometrial cancer patients, those living in rural areas, and are there specific challenges that these women in rural areas face in accessing timely and quality healthcare services for endometrial cancer screening and treatment?

Dr. Emily Hinchcliff: 

Absolutely. So, when I think of barriers, I think that barriers can be broken into some really key steps along the kind of diagnosis continuum. So certainly, a patient needs to understand that the symptom that they’re having is a problem. Then they need to see that problem and seek care. Then once they have established care they need to obtain a diagnosis. And then once you have a diagnosis, you need to get treated. And so I would suspect that those living remote from major hospital centers or from subspecialty care probably experience delays at each single one of those time points.

First, I think a knowledge gap probably exists about what bleeding should be, especially for postmenopausal women. Postmenopausal bleeding is not normal. And so even a small episode of spotting should warrant a visit to your physician. And then I think for those who see their physician, who have a less kind of either geographic or less access for whatever reason, there’s probably a greater prolongation of the series of visits that are required before they get the necessary endometrial sampling and a transvaginal ultrasound, which are really core tests when it comes to diagnosis.

Once the diagnosis is obtained, I think that the further referral and potential delay to someone like myself, like a GYN oncologist, is also a key barrier for those who are rural. There’s actually a really good study in gynecologic specifically in the Midwest that showed that rural women were significantly less likely to receive care from a subspecialist like myself.  I think that particular study was in endometrial, sorry in ovarian cancer, but it showed that those who receive care by a specialist are more likely to get optimal surgery and to get guideline-inherent care. So getting yourself to that subspecialist, I think is really key, but can be difficult for women who live remote from subspecialty care.


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Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality

Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality from Patient Empowerment Network on Vimeo.

What are endometrial cancer risk factors for patients should know about? Expert Dr. Emily Hinchcliff from Northwestern Medicine discusses endometrial cancer risk factors, incidence and mortality rates, and patient advice to help guard against endometrial cancer.

[ACT]IVATION TIP

“…lifestyle modification is really important here. Obesity is a known risk factor for endometrial cancer. So working with your primary care physician to try to improve your health more generally, especially as it surrounds weight, is really important in terms of endometrial cancer prevention. I also think it’s important to know…that obesity and changing your obesity can impact your cancer’s response to certain therapies, especially with hormonal therapy.”

See More from [ACT]IVATED Endometrial Cancer

Related Resources:

Which Endometrial Cancer Clinical Trials Are Showing Promise

Which Endometrial Cancer Clinical Trials Are Showing Promise?

Overcoming Barriers: Empowering Underrepresented Groups With Endometrial Cancer

Overcoming Barriers: Empowering Underrepresented Groups With Endometrial Cancer

Overcoming Geographical Barriers in Endometrial Cancer Care

Overcoming Geographical Barriers in Endometrial Cancer Care

Transcript:

Lisa:

Dr. Hinchcliff, for patients wondering about their risk, what are risk factors for endometrial cancer, and what should patients be aware of?

Dr. Emily Hinchcliff:  

So I think that it’s really important to highlight that endometrial cancer is one of the few cancers that is actually increasing in both number and also mortality. The numbers from the American Cancer Society for 2024 are over 70,000 women, or around 70,000 women will be diagnosed, and around 13,000 women will die of their disease. And I think that unlike many cancers where we’re actually making progress, endometrial cancer, the incidence, how many people are getting it is rising. And it’s rising faster in non-white ethnicities and groups.

So as I think about risk factors, I think the important ones to highlight are certainly obesity. This I think is a large driver of why there is increasing incidence of endometrial cancer. This relates to kind of the hormonal regulation. Obesity results in increasing levels of estrogen that disproportionately affect the endometrium. And then similar to that, certain hormonal syndromes where women have irregular or infrequent periods like polycystic ovarian syndrome can also put them at higher risk. More globally, I think age, family history are also risk factors. And then as I mentioned, unfortunately, women who are non-white have a higher risk of endometrial cancer mortality, especially as relates to some of the higher risk endometrial cancer subtypes.

Lisa:

Do you have an activation tip for patients for that question?

Dr. Emily Hinchcliff: 

Yeah, so I think that lifestyle modification is really important here. Obesity is a known risk factor for endometrial cancer. So working with your primary care physician to try to improve your health more generally, especially as it surrounds weight, is really important in terms of endometrial cancer prevention. I also think it’s important to know, given that this is often a patient audience that I’m speaking to, that obesity and changing your obesity can impact your cancer’s response to certain therapies, especially with hormonal therapy. So for women who are diagnosed with early stage endometrial cancer, for example, who may desire fertility preservation or may want to know what they can do to impact their own cancer care, I think that’s a really important point.

I guess I can also just bring up a quick one-liner regarding the recent publication of studies surrounding hair product use. So this is a question that we have been getting asked a lot after the publication of both the study and then the big New York Times article, but there was an NIH study that showed a potential association between hair product chemical straightener use and uterine cancer, especially for those who identify as frequent users. I think that the important key point here is that around 60 percent of the women who reported using hair products self-identified as Black and tend to initiate use earlier, so this is another risk factor that may be important.

Yeah, we’re still learning a lot more about that. Right now, there’s an unclear association in terms of what we should be doing about it.


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Which Endometrial Cancer Clinical Trials Are Showing Promise?

Which Endometrial Cancer Clinical Trials Are Showing Promise? from Patient Empowerment Network on Vimeo.

Which endometrial cancer clinical trials are showing encouraging results? Expert Dr. Emily Hinchcliff from Northwestern Medicine shares insight about novel therapies and combinations and advice for patients to be proactive in their care. 

[ACT]IVATION TIP

“…understand what clinical trials are available to your physician and to you at the place that you are currently getting treated. And then also understand more globally what other clinical trials might be out there. And that’s a great question to ask your physician.”

See More from [ACT]IVATED Endometrial Cancer

Related Resources:

Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality

Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality

Endometrial Cancer Care Disparities | The Impact of Rural Residence

Endometrial Cancer Care Disparities: The Impact of Rural Residence

Overcoming Geographical Barriers in Endometrial Cancer Care

Overcoming Geographical Barriers in Endometrial Cancer Care

Transcript:

Lisa:

What ongoing clinical trials are investigating novel therapies for advanced endometrial cancer? And can you provide some insights into any promising experimental treatments that have shown encouraging results in early phase trials?

Dr. Emily Hinchcliff

Absolutely. So I think that the use of immunotherapy in endometrial cancer has been a true game changer.  It has changed the landscape of how we think about treating this disease. I think the cutting edge now is to try and understand whether immunotherapy in combination with our more traditional chemotherapy, cytotoxic chemotherapies that basically kill cells rapidly dividing as compared to immunotherapy, which helps to kill cancer cells by using the immune system. So should we be using immunotherapy in addition to, or even instead of some of those traditional chemotherapy options? There are also many, many clinical trials that are investigating novel combinations and novel targeted agents, especially for the high-risk tumor subsets.

So endometrial cancer is a broad umbrella term for many different subtypes. And the higher risk subtypes often are those that are harder to treat with our standard therapies. And so many trials are specifically trying to target better options for these patients. I think that one trial that I will just highlight in addition to some of the immunotherapies are immune therapy combinations with what are called anti-angiogenics. So drugs that try to prevent the tumor from growing its own blood supply.

And then also immunotherapy in combination with another class of drugs called PARP inhibitors which are more commonly used in ovarian cancer but which in combination with immunotherapy may be a new avenue for effective treatment.

Lisa:

And do you have an activation tip for patients for that question?

 Dr. Emily Hinchcliff:  

Absolutely, so I think that my activation tip for patients surrounding novel therapies in endometrial cancer is to understand what clinical trials are available to your physician and to you at the place that you are currently getting treated. And then also understand more globally what other clinical trials might be out there.

And that’s a great question to ask your physician. I think that your physician can help you to decide is a standard of care therapy the right choice for you at this point in your treatment, in your cancer journey, or are you at a point where a clinical trial may be of benefit either because of the expected efficacy of the standard of care, or because of the potential benefits of that clinical trial, or even because of the side effect profiles of either of those options.


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Evolve Endometrial Cancer Resource Guide

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How Can You Access Personalized Medicine for Endometrial Cancer?

How Can You Access Personalized Medicine for Endometrial Cancer? from Patient Empowerment Network on Vimeo.

How can endometrial cancer patients access the most personalized treatment approach for their individual disease? This animated video reviews key treatment considerations, the impact of biomarker test results on therapy options, and advice for engaging in care decisions. 

Related Programs:

Endometrial Cancer Treatment and Research Updates

What Are Treatment Options for Endometrial Cancer?

Endometrial Cancer Treatment Decisions | Factors That Impact Your Options

Endometrial Cancer Treatment Decisions | Factors That Impact Your Options


Transcript:

Endometrial cancer research is evolving quickly, leading to targeted treatment approaches and helping patients access more personalized care.   

So, what is personalized medicine? Personalized medicine – also called precision medicine – is a type of care that is based on the genetic makeup and individual characteristics of a patient’s disease.  

This information is gathered using biomarker testing, which identifies key markers such as genes, proteins, or other molecules in a sample of tissue, blood, or other bodily fluid. The results of this testing can give a more detailed picture of the tumor’s type, aggressiveness, and may help predict how the cancer will behave. 

The test results can also identify which treatment approach may be most effective, through the presence of certain molecular markers.  For example, if biomarker testing results reveal that a tumor has either high microsatellite instability (MSI high) or mismatch repair defects (dMMR), an endometrial cancer patient may benefit from immunotherapy.  

Or, if the results show the HER-2 or mTOR mutation, this could indicate that the disease may respond well to a targeted therapy. And the presence of estrogen or progesterone receptors in a patient’s tumor may suggest hormonally targeted therapies may be beneficial. 

In addition to biomarker test results, other factors that physicians consider when recommending a treatment approach include:  

  • A patient’s age, overall health, and any pre-existing conditions. 
  • The type, stage, and grade of endometrial cancer.
  • And the patient’s preference. 

When considering treatment, patients should discuss the pros and cons of each option with their doctor. And they should review potential side effects, understand how the treatment is administered, and how the therapy may impact their lifestyle.  

So, what steps can YOU take to access personalized care? 

  • Find out if your doctor has experience treating endometrial cancer. Consulting a specialist or getting a second opinion can help confirm your diagnosis and treatment plan. 
  • Next, request all essential testing, including biomarker testing, and discuss how the results may impact prognosis and therapy options.  
  • You should also ensure that you understand ALL of the treatments available to you – including clinical trials.
  • And, make sure to have a friend or loved one present during discussions, so you can talk about the information later and feel confident in your decisions.
  • Finally, don’t hesitate to share your opinion and ask questions about available options. Remember, YOU should be at the center of your endometrial cancer care. 

To learn more about endometrial cancer and to access tools for self-advocacy, visit powerfulpatients.org/endometrial  

Endometrial Cancer Treatment Decisions | Factors That Impact Your Options

Endometrial Cancer Treatment Decisions | Factors That Impact Your Options from Patient Empowerment Network on Vimeo.

Endometrial cancer expert Dr. Emily Ko explains health considerations and other key factors that may impact options when determining an optimal treatment approach for each patient. 

Dr. Emily Ko is a gynecologic oncologist and Associate Professor of Obstetrics and Gynecology at the University of Pennsylvania. Learn more about Dr. Ko.

 

Related Programs:

How Is Endometrial Cancer Staged?

How Is Endometrial Cancer Staged?

What Are Treatment Options for Endometrial Cancer?

What Are Treatment Options for Endometrial Cancer?


Transcript:

Katherine:

Dr. Ko, what goes into determining a treatment approach for an individual patient? Is there key testing that helps guide a patient’s prognosis and treatment options? 

Dr. Ko:

Absolutely. So, I think the key pieces of information come from several sources. First, we do take the whole patient into account, like baseline health, baseline function, meaning every day, how active are you? Are there limitations to your daily activities? Looking at baseline health conditions, what we call comorbidities. Are there other health conditions, like diabetes, heart conditions, lung condition, kidney conditions, that could really impact a patient’s overall health and well-being? That is always part of it, number one. 

Then, we look specific to the cancer details. So, from all the pathology information, biopsies, followed by a surgical staging procedure, what exact stage, what exact substage, and we might even look at other unique features. Was there cells that got into the lymph vessels, the lymph nodes? Are there other just features from a pathology standpoint that are important, like the – I talked about microsatellite status, microsatellite instable versus microsatellite stable. 

Those are all information we can gather from the tumor tissue itself. That then kind of tailors our therapy. And then, like I was saying, now we’re going into this molecular era where we can actually take that tumor tissue and even do more expanded testing on it. 

So, I think it’s worthwhile to talk to your provider and say, “Hey, would it be worthwhile to send my tumor out for expanded testing, whether it’s done at your institution, at a specialized lab, or whether it’s sent out to a company that does expanded testing?” Because then, they might be able to test for 500 different genetic signatures, a much more broad panel, but that might open the door for opportunities to say, “Hey, you actually do have a very unique signature, and maybe it is worth tailoring your therapy even further.” 

So, I think these are very important questions to have with your provider, and these pieces of information can help guide the prognosis. I think we’re always asking what does this mean long-term, and I think when we have all these individual pieces of information, we can then give guidance on that.   

Katherine:

I wanted to get your point of view on why is it important for patients to engage in their care and their treatment decisions?  

Dr. Ko:

Right. I think that it is so important. Medical treatments, I think, do work the best for the patient when the patient is truly an active participant, and what I mean by that is I think we can really understand the patient if there’s a conversation, there’s a mutual discussion, and I think every patient has unique circumstances, has unique goals, has…whether it’s just the daily whatever responsibilities, or just either health or non-health concerns that they have, we want to be able to find a treatment that fits the patient, and we realize that one treatment doesn’t fit all. 

And so, the more, I think, that there is this mutual discussion, mutual understanding, then there’s a mutual decision treatment plan that is made, and there’s the more ability to modify that plan when – if you realize, oh, maybe we can tailor it, maybe we try one thing, and maybe we realize we got to change a little bit. 

And, I think that with a cancer condition, it is a journey. It is not just a one-time thing. It really is a journey, and I think that the more a patient can participate throughout that journey, I think the better the outcomes for the patient, and honestly, the better the treatment course will be for everyone participating.  

Katherine:

Why should a patient consider finding an endometrial cancer specialist? What are the benefits? 

Dr. Ko:

So, I think naturally, an endometrial cancer specialist is a provider who spends more time thinking about the disease, reading about it, looking at what’s the newest research studies that are coming out, what are the available clinical trials here, locally, regionally, or nationally, what are other support services available for the patient in the space. 

And, of course, probably the folks that do the most surgeries gear towards endometrial cancer patients, and so, I think just working in that space naturally then brings more resources and more opportunity for the patient to kind of really know what’s out there, what is the newest, and I think that really benefits the patient. 

Monitoring for an Endometrial Cancer Recurrence

Monitoring for an Endometrial Cancer Recurrence from Patient Empowerment Network on Vimeo.

How are endometrial cancer patients monitored for a recurrence? Expert Dr. Emily Ko shares insight about how monitoring is tailored to a patient’s individual disease and discusses the frequency of observation.

Dr. Emily Ko is a gynecologic oncologist and Associate Professor of Obstetrics and Gynecology at the University of Pennsylvania. Learn more about Dr. Ko.

 

Related Programs:

Endometrial Cancer Treatment and Research Updates

What Should Endometrial Cancer Patients Know About Clinical Trials?

How Is Endometrial Cancer Staged?

How Is Endometrial Cancer Staged?


Transcript:

Katherine:

How are patients monitored for a recurrence, and are there approaches to help prevent a recurrence? 

Dr. Ko:

Sure, absolutely. Great question. It is important to continue monitoring patients, even after they’ve gone through treatment. So, I think of it as a multifaceted approach. Usually, it includes office visits, including a physical exam. It includes a thorough intake of all of their symptoms. 

It also includes – depending on the scenario – in some circumstances, regular imaging studies, such as a CT scan or MRI, and sometimes, we also do things like PET scans, and I think that does have to be tailored to the unique patient’s endometrial cancer, unique case, stage, histology, and we kind of tailor which tests we choose to do. The interval of monitoring can vary, so I would say generally speaking, it could be anywhere from three- to six-month visits, and with potentially added scans, as we talked about, and sometimes, we also do certain blood tests in certain cases where we may choose to follow a CA125 blood tumor marker. 

But, I would say that there are different, definitely variants to how we choose to monitor, and there are certain resources we tend to use, such as the NCCN guidelines that providers may reference, and sometimes may even share with the patients to explain why and how we choose to do the monitoring. 

What Are Treatment Options for Endometrial Cancer?

What endometrial cancer treatment options are currently available? Endometrial cancer expert Dr. Emily Ko shares an overview of options, including chemotherapy, surgery, radiation, targeted therapies, combination therapies, hormonal therapies, and discusses considerations for patients who are trying to preserve their fertility.

Dr. Emily Ko is a gynecologic oncologist and Associate Professor of Obstetrics and Gynecology at the University of Pennsylvania. Learn more about Dr. Ko.

 

Related Programs:

How Is Endometrial Cancer Staged?

How Is Endometrial Cancer Staged?

Monitoring for an Endometrial Cancer Recurrence

Monitoring for an Endometrial Cancer Recurrence


Transcript:

Katherine:

I’d like to talk about the treatments that are currently available. You mentioned chemotherapy, but what else is available for people? 

Dr. Ko:

Absolutely. So, treatment for endometrial cancer is usually some combination of surgery, and then it may be followed by possibly chemotherapy, as well as radiation, and sometimes, it may be a combination of all three treatments, or sometimes, it’s a combination of one or two of those, depending on the exact stage, depending on the exact cell type, and some of the other factors. 

Katherine:

Are hormonal therapies used as well, and targeted therapies? 

Dr. Ko:

Yes. 

Katherine:

I know they are in other cancers. 

Dr. Ko:

Yes. And so, I think the question is where do those come into play? So, I would say the usual algorithm most commonly would be that surgery is done first, as the most common first step, and then, based on the information obtained from surgery and the pathology report that comes from that, then there’s usually some type of a recommendation about should there be a second stepped treatment, and that frequently can be chemotherapy/radiation.  

Now, the areas where targeted therapy – for example, immunotherapy – where does that come in? So, that now has come into the – I would call it the second stage. We’re combining it with the classic chemotherapy drugs – Taxol-carboplatin, for example. That’s one example where it could come into play. Another example could come into play where a patient had gone through classic Taxol/paclitaxel and carboplatin, then had cancer come back, and so, that could be another instance where that pembrolizumab or pembro with lenvatinib (Lenvima) combination can be used in the setting of recurrence. 

Now, we could also say, hey, if your cancer type has those hormonal receptors present or is some type of what we call endometrioid histology, and we think that hormonal therapy may be more effective in that case, then that could also be used in a setting where the cancer has kind of grown again, the cancer has grown back, or actually, there are certain situations where patients, for example, may not undergo a hysterectomy. 

And, there are unique cases and those situations where patients are still trying to preserve their fertility, and therefore not wanting to undergo a hysterectomy, or they’re unable to undergo surgery safely. And so, in some unique situations, we may also use hormonal therapy as the mechanism to treat their cancer, and whether that is by way of a pill, whether that is by way of a progesterone intrauterine device, IUD, that is placed into the uterus, we also have situations where we tailor the therapy to the condition of the patient. 

Katherine:

When treating more advanced endometrial cancer disease in general, are the treatment options different than if you were treating somebody who had stage I or stage II, for instance? 

Dr. Ko:

Sure, great question. So, for some patients with, say, stage I, surgery alone is enough. 

For some other patients, subcategories of stage I, where we call them more high/intermediate-risk patients, they’re stage I, but there are a few features about their pathology that might make them slightly higher risk for recurrence – in those cases, we might consider a little bit of radiation after surgery, what we call adjuvant radiation or what we call radiation vaginal brachytherapy. Just three short treatments of a little bit of radiation to the top of the vagina has been shown to possibly decrease chance of recurrence in that area with very minimal side effects. 

So, that would be more commonly in line with stage I. There are some subtypes that can still be what we call high-risk, even in stage I/stage II uterine serous carcinoma, uterine carcinosarcoma. In those cases, we might also recommend chemotherapy along with some vaginal brachytherapy following their hysterectomy, so that’s the early stage. 

And then, with the advanced stage, yes. So, frequently, it’d be surgery first to secure the diagnosis, followed by some type of – it might be primarily chemotherapy, or it could be combination chemotherapy with radiation. And over time, I would say our paradigm for what we use for chemotherapy and radiation has changed a little bit.  

If you go back a couple decades, I think radiation was used a lot – whole pelvic radiation, even just without any chemotherapy. And then, we then had more data from research clinical trials, GOG-258 or PORTEC-3, that then had given us evidence that perhaps doing chemotherapy with some combination of radiation is going to be beneficial, or even moving towards primarily radiation could be a very good option in terms of long-term benefit/long-term survival. 

And, of course, that brings us to the present day, those two trials that I mentioned from ASCO, the GY018 and the RUBY, now bringing in the immunotherapy component to the chemotherapy, so there has definitely been an evolution to managing advanced stage. 

What Should Endometrial Cancer Patients Know About Clinical Trials?

 

What Should Endometrial Cancer Patients Know About Clinical Trials? from Patient Empowerment Network on Vimeo.

Should endometrial cancer patients consider a clinical trial as a treatment option? Expert Dr. Emily Ko reviews the potential benefits of participating in a clinical trial.

Dr. Emily Ko is a gynecologic oncologist and Associate Professor of Obstetrics and Gynecology at the University of Pennsylvania. Learn more about Dr. Ko.

Related Programs:

How Is Endometrial Cancer Staged?

How Is Endometrial Cancer Staged?

What Are Treatment Options for Endometrial Cancer?

What Are Treatment Options for Endometrial Cancer?


Transcript:

Katherine:

Well, you just mentioned clinical trials, and I think it’s a good topic to cover a little bit. Why is it important for patients to actually consider enrolling? What are the benefits for them? 

Dr. Ko:

Sure. So, while we certainly have a good armamentarium of standard-of-care therapies already, and I should mention that does include our classic chemotherapy drugs like paclitaxel (Abraxane), carboplatin (Paraplatin), and even doxorubicin (Adriamycin), if you will, or doxorubicin Hcl (Doxil), there are the immunotherapy drugs now that have become standard of care as well, like pembrolizumab (Keytruda), but sometimes, despite using those best available drugs, the cancer unfortunately either continues to grow or you had a good response, but somehow it shows up again – the cancer shows up again – and so, then, we’re looking for additional opportunities, additional therapies. 

And so, some of the best opportunities are actually to consider these clinical trials. The way that clinical trials are designed is that they always are going  to provide you at least a backbone of a standard available therapy, so you’re never going to get less than what would be considered standard of care. 

But, what they’re doing is they’re usually partnering another drug – a more novel therapy – or they’re basically testing a more novel therapy that could be more targeted, that could potentially have better efficacy than what’s already available standardly. And so, the value of that is that you could have an opportunity to have a therapy that could work even better. 

When you’ve tried something already, unfortunately, the cancer has grown, there is still opportunity, and while you’re on a clinical trial, I think one of the huge benefits is it’s very regulated. You are monitored so closely because at the base of all of this is safety. There is never going to be a drug or therapy that’s going to be administered to a patient without ensuring that there’s absolute safety for that patient, and so, that’s a way that you really have opportunity to get more treatment that could really help your cancer condition and do it in a very, very safe, formal fashion. 

Katherine:

And ultimately help others as well, in the future. 

Dr. Ko:

Exactly, absolutely, because as you’re participating in this process – and, of course, it’s a voluntary process to participate on a clinical trial, so we so appreciate all the patients who, in the past, have participated and are willing to participate in the future, but allows us also to really gather a lot of information to really inform cancer treatment for all the patients coming down the road, and those could be anyone. They could be our neighbors, our friends, our own family members, and that could really be so helpful to everyone that’s going through this type of thing. 

Katherine:

Absolutely, yeah. I’d like to back up a bit and talk about what endometrial cancer is. It’s often referred to as uterine cancer. So, are they the same thing? Are these terms interchangeable? 

Dr. Ko:

Sure, it’s a great question. So, endometrial cancer refers to cancer that starts in what I call the lining of the uterine cavity. So, inside the uterus, there’s a uterine cavity, and there’s a tissue that coats that cavity, and that’s called the endometrium. So, endometrial cancer is basically when cancer cells start growing from that tissue. And, of course, since that exists in the uterus, of course, it’s considered uterine cancer, and we’re just being a little bit more specific when we say endometrial cancer. But, of course, endometrial cancer is the most common form of uterine cancer by far, so in some ways, it’s almost – it’s synonymous. 

How Is Endometrial Cancer Staged?

 

How Is Endometrial Cancer Staged? from Patient Empowerment Network on Vimeo.

What are the stages of endometrial cancer? Expert Dr. Emily Ko explains factors involved in analysis for staging and what occurs in the body during each stage.

Dr. Emily Ko is a gynecologic oncologist and Associate Professor of Obstetrics and Gynecology at the University of Pennsylvania. Learn more about Dr. Ko.

Related Programs:

Endometrial Cancer Treatment and Research Updates

What Should Endometrial Cancer Patients Know About Clinical Trials?

What Are Treatment Options for Endometrial Cancer?

What Are Treatment Options for Endometrial Cancer?


Transcript:

Katherine:

How is endometrial cancer staged? 

Dr. Ko:

So, the most classic, rigorous way to stage endometrial cancer is through a surgical procedure. So, what that usually involves is it does include a hysterectomy, removing the uterus and the cervix, usually also includes removing the fallopian tubes and the ovaries.  

And, at the same time, the surgeon will do a very thorough assessment of the abdominal pelvic cavity, basically looking around all those areas to see if there’s any signs of visible disease, anything they can see that looks like it could be tumor deposits in the abdominal cavity. If anything is seen, those deposits will be removed and biopsied, so that’s part of the staging procedure. 

And additionally, it’s important to try to assess the lymph nodes, typically. So, there are lymph nodes in the pelvic area, and then, higher up along the aortic area, and so, there are different surgical techniques that we can use to basically test or sample some of those lymph nodes, be able to remove them, send them to the pathologist, look under the microscope to see if there are any microscopic cancer cells that have traveled to those lymph nodes. 

So, that is all part of a surgical procedure, and with all the information collected from those tissue samples that are removed from the body and sent to the pathologist, but the pathologist then reviews all of that under a microscope, and then can issue a very thorough report describing where the cancer cells are located, and by definition, where the cancer cells are located then defines what the stage is of the cancer. 

Katherine:

Can you give me an example?  

Dr. Ko:

Of course. So, for example, if the cancer cells are located only in the uterus, and they’re not found anywhere else, then that is a stage I. If the cancer cells have traveled to the cervix area specifically, this we call a cervical stroma, that becomes a stage II. If the cancer cells have, for example, traveled to the fallopian tubes, or the ovaries, or the lymph nodes, then that becomes a stage III, and there are sort of substages within those categories as well. 

Katherine:

But stage III would be the highest or most severe? 

Dr. Ko:

So, there’s stage III, and then there’s actually stage IV. So, if the cancer cells have traveled outside of the pelvis into the abdominal area, then we consider that a stage IV. 

Katherine:

And that would be considered advanced endometrial cancer? 

Dr. Ko:

Right. So, by definition, “advanced” typically refers to stage III or IV. 

Endometrial Cancer Treatment and Research Updates

Are there advances in endometrial cancer research that patients should know about? Expert Dr. Emily Ko shares updates about ongoing clinical trials, including immunotherapy and combination approaches, and discusses how endometrial cancer subtypes affect treatment options. 
 
Dr. Emily Ko is a gynecologic oncologist and Associate Professor of Obstetrics and Gynecology at the University of Pennsylvania. Learn more about Dr. Ko.

Related Programs:

What Should Endometrial Cancer Patients Know About Clinical Trials?

How Is Endometrial Cancer Staged?

How Is Endometrial Cancer Staged?

What Are Treatment Options for Endometrial Cancer?

What Are Treatment Options for Endometrial Cancer?


Transcript:

Katherine:

Well, let’s start by learning about the latest research news. Just this June, endometrial cancer researchers from around the world met to discuss their findings at the annual American Society of Clinical Oncology meeting, or ASCO, in Chicago. Can you walk us through the highlights that patients should know about? 

Dr. Ko:

Sure. So, the ASCO meeting is a very big meeting that happens once a year in June, and really, it is a national – actually, international – meeting where the biggest breakthroughs in cancer therapy are really presented and discussed. 

So, within the field of gynecologic cancer and specifically endometrial cancer, we really saw a couple breakthrough clinical trial results, if you will. The two specific trials that have hit the spotlight – and, it was presented at ASCO; they were also previously presented at the Society of Gynecologic Oncology annual meeting in March of 2023. These two trials – one of them is called GY018, and the other one is called RUBY, and these two trials specifically were geared at patients with endometrial cancer of either advanced stage, meaning stage III or IV at diagnosis, or patients who have recurrent endometrial cancer.  

And, these both trials were very large, multisite, international trials enrolling a huge number of patients. They were randomized controlled trials, meaning that they were specifically testing what we call a standard therapy, Taxol-carboplatin, versus a standard therapy plus a newer agent, and that newer agent falls in the realm of an immunotherapy drug. 

So, with this kind of novel approach, where we’re combining standardly used chemotherapy plus a newer immunotherapy drug, the question was if you did this combination, would patients have a better outcome? And, in fact, the groundbreaking news was that yes, patients did have a better outcome with this new combination of therapy, and this was shown in various forms of results. 

One of the primary outcomes is always something called survival, and with the GY018, they looked at progression-free survival as a primary outcome, and it did show that patients on this new combination did better with progression-free survival. And the difference was about median of about three months. Now, that may not sound like a whole lot. However, in the realm of cancer therapy, when you take a very large group of patients, that was a meaningful difference that was statistically significant. 

And furthermore, as we’re moving forward with our therapy drugs, we are moving into this era of targeted therapy, precision medicine, where we’re really trying to hone into more the specifics of the biology of each person’s cancer, and not treating everyone the same. 

What’s interesting with these two trials is when they looked at different subpopulations of patients with advanced or recurrent endometrial cancer, whether they had a type of endometrial cancer that was considered MSI-high, or a microsatellite instable type of cancer, which basically refers to a certain biology of these endometrial cancers, it has to deal with how the cells – the cancer cells – behave, how they’re able to not follow the rules and be able to replicate themselves.  

The patients who are MSI-high particularly had a really great response with this chemotherapy, so it was even beyond just a three-month difference. With that being said, even in patients who are what we call microsatellite-stable, who didn’t have this unique signature, they still saw a benefit with this novel combination, and to add to that, the nice thing about it is the toxicities were not bad. Even this new combination was very well-tolerated. 

It was not a high rate of severe toxicities or side effects, if you will, and that actually, the great majority of patients were able to stay on this therapy and really get through – complete the therapy course.  

So, there are some sort of nuanced differences between the two trials I mentioned, GY018 versus the RUBY. And some of those details are with regards to the even specific subtype of endometrial cancer, which we haven’t talked about yet, for example, uterine carcinosarcoma versus uterine serous carcinoma, uterine clear cell, uterine endometrioid – these are all specific subtypes of endometrial cancer. So there are some nuances where the RUBY trial was able to include patients with uterine carcinosarcoma, whereas the GY018 did not. 

But suffice it to say, now we have enough data that virtually all endometrial cancer patients with advanced stage, regardless of what histology, there is essentially a trial that can apply to you where it demonstrated this added benefit to doing this novel combination, and that was found with microsatellite-stable patients as well as microsatellite-instable in both randomized controlled trials that I mentioned. 

Katherine:

Dr. Ko, are there other research or treatment advances that patients should know about? 

Dr. Ko:

Certainly. Like I mentioned, we’re really moving towards the realm of treating with a targeted therapy approach, and within endometrial cancer, the prior paradigm was much simpler, but really not in the space of target therapy. So, for example, what does that mean? 

So, as we’re realizing that there are very unique biologic signatures to different patients’ endometrial cancer – there could be, for example, some cancers that are particularly receptive to hormonal therapy, meaning their specific cancer, when we send it for detailed – we call it genomic or somatic testing, we can discover, oh, they have estrogen-receptor-positive, progesterone-receptor-positive, and so, those type of cancers may be very responsive to hormonal-based therapy, and in that space, we have a standard available drugs, but we also have clinical trials that are trying newer drugs. 

If, for example, the standard aromatase inhibitor or the standard progesterone agent may be helpful, but there are even more in that space that this point – CDK inhibitors that you can combine with these aromatase inhibitors or hormonal agents that have been around for longer that have shown a lot of promise, a lot of data in breast cancer. But now we’re realizing, wow, there could be some efficacy in endometrial cancer as well, so that’s just one example.  

And there’s other unique biologic gene signatures, again, kind of a good list now out there, that are being studied in various clinical trials, whether they’re PARP inhibitors, whether they’re drugs that target CCNE1, whether they’re drugs that target ARID1A, so there are actually many more that are available. So, they’re really expanding the opportunity for treatment for endometrial cancer patients. 

PODCAST: What Do You Need to Know About Emerging Endometrial Cancer Research?

 

Endometrial cancer treatment and research is evolving quickly. Dr. Emily Ko provides an update on new and emerging approaches, explains how these therapies work to treat endometrial cancer, and shares tips for partnering with your team on key decisions.
 
Dr. Emily Ko is a gynecologic oncologist and Associate Professor of Obstetrics and Gynecology at the University of Pennsylvania. Learn more about Dr. Ko.

See More from Evolve Endometrial Cancer

Transcript:

Katherine:

Hello, and welcome. I’m your host, Katherine Banwell. Today’s program focuses on helping patients with endometrial cancer learn more about evolving research and treatments. We’re also going to discuss how patients can collaborate with their team on care decisions. Before we meet our guest, let’s review a few important details. The reminder email you received about this program contains a link to program materials. If you haven’t already, click that link to access information to follow along during the webinar. 

At the end of the program, you’ll receive a link to a program survey. Please take a moment to provide feedback about your experience today in order to help us plan future webinars. And finally, before we get into the discussion, please remember that this program is not a substitute for seeking medical advice. Please refer to your healthcare team about what might be best for you. Well, let’s meet our guest today. Joining us is Dr. Emily Ko. Dr. Ko, welcome. Would you please introduce yourself? 

Dr. Ko:

Surely. Thank you so much. My name is Dr. Emily Ko, and I am a gynecologic oncologist. Currently, I’m an associate professor at the University of Pennsylvania, and as part of my daily work, I see patients, I provide surgical and medical treatments for gynecologic cancers, and I also am a researcher involved particularly in endometrial cancer. 

Katherine:

Thank you so much for taking the time out of your schedule to join us today. 

Dr. Ko:

Thank you. 

Katherine:

Well, let’s start by learning about the latest research news. Just this June, endometrial cancer researchers from around the world met to discuss their findings at the annual American Society of Clinical Oncology meeting, or ASCO, in Chicago. Can you walk us through the highlights that patients should know about? 

Dr. Ko:

Sure. So, the ASCO meeting is a very big meeting that happens once a year in June, and really, it is a national – actually, international – meeting where the biggest breakthroughs in cancer therapy are really presented and discussed. 

So, within the field of gynecologic cancer and specifically endometrial cancer, we really saw a couple breakthrough clinical trial results, if you will. The two specific trials that have hit the spotlight – and, it was presented at ASCO; they were also previously presented at the Society of Gynecologic Oncology annual meeting in March of 2023. These two trials – one of them is called GY018, and the other one is called RUBY, and these two trials specifically were geared at patients with endometrial cancer of either advanced stage, meaning stage III or IV at diagnosis, or patients who have recurrent endometrial cancer.  

And, these both trials were very large, multisite, international trials enrolling a huge number of patients. They were randomized controlled trials, meaning that they were specifically testing what we call a standard therapy, Taxol-carboplatin, versus a standard therapy plus a newer agent, and that newer agent falls in the realm of an immunotherapy drug. 

So, with this kind of novel approach, where we’re combining standardly used chemotherapy plus a newer immunotherapy drug, the question was if you did this combination, would patients have a better outcome? And, in fact, the groundbreaking news was that yes, patients did have a better outcome with this new combination of therapy, and this was shown in various forms of results. 

One of the primary outcomes is always something called survival, and with the GY018, they looked at progression-free survival as a primary outcome, and it did show that patients on this new combination did better with progression-free survival. And the difference was about median of about three months. Now, that may not sound like a whole lot. However, in the realm of cancer therapy, when you take a very large group of patients, that was a meaningful difference that was statistically significant. 

And furthermore, as we’re moving forward with our therapy drugs, we are moving into this era of targeted therapy, precision medicine, where we’re really trying to hone into more the specifics of the biology of each person’s cancer, and not treating everyone the same. 

What’s interesting with these two trials is when they looked at different subpopulations of patients with advanced or recurrent endometrial cancer, whether they had a type of endometrial cancer that was considered MSI-high, or a microsatellite instable type of cancer, which basically refers to a certain biology of these endometrial cancers, it has to deal with how the cells – the cancer cells – behave, how they’re able to not follow the rules and be able to replicate themselves. 

The patients who are MSI-high particularly had a really great response with this chemotherapy, so it was even beyond just a three-month difference. With that being said, even in patients who are what we call microsatellite-stable, who didn’t have this unique signature, they still saw a benefit with this novel combination, and to add to that, the nice thing about it is the toxicities were not bad. Even this new combination was very well-tolerated. 

It was not a high rate of severe toxicities or side effects, if you will, and that actually, the great majority of patients were able to stay on this therapy and really get through – complete the therapy course. 

So, there are some sort of nuanced differences between the two trials I mentioned, GY018 versus the RUBY. And some of those details are with regards to the even specific subtype of endometrial cancer, which we haven’t talked about yet, for example, uterine carcinosarcoma versus uterine serous carcinoma, uterine clear cell, uterine endometrioid – these are all specific subtypes of endometrial cancer. So there are some nuances where the RUBY trial was able to include patients with uterine carcinosarcoma, whereas the GY018 did not. 

But suffice it to say, now we have enough data that virtually all endometrial cancer patients with advanced stage, regardless of what histology, there is essentially a trial that can apply to you where it demonstrated this added benefit to doing this novel combination, and that was found with microsatellite-stable patients as well as microsatellite-instable in both randomized controlled trials that I mentioned. 

Katherine:

Such exciting news! That’s great! Well, beyond ASCO, Dr. Ko, are there other research or treatment advances that patients should know about?  

Dr. Ko:

Certainly. Like I mentioned, we’re really moving towards the realm of treating with a targeted therapy approach, and within endometrial cancer, the prior paradigm was much simpler, but really not in the space of target therapy. So, for example, what does that mean? 

So, as we’re realizing that there are very unique biologic signatures to different patients’ endometrial cancer – there could be, for example, some cancers that are particularly receptive to hormonal therapy, meaning their specific cancer, when we send it for detailed – we call it genomic or somatic testing, we can discover, oh, they have estrogen-receptor-positive, progesterone-receptor-positive, and so, those type of cancers may be very responsive to hormonal-based therapy, and in that space, we have a standard available drugs, but we also have clinical trials that are trying newer drugs. 

If, for example, the standard aromatase inhibitor or the standard progesterone agent may be helpful, but there are even more in that space that this point – CDK inhibitors that you can combine with these aromatase inhibitors or hormonal agents that have been around for longer that have shown a lot of promise, a lot of data in breast cancer. But now we’re realizing, wow, there could be some efficacy in endometrial cancer as well, so that’s just one example. 

And there’s other unique biologic gene signatures, again, kind of a good list now out there, that are being studied in various clinical trials, whether they’re PARP inhibitors, whether they’re drugs that target CCNE1, whether they’re drugs that target ARID1A, so there are actually many more that are available. So, they’re really expanding the opportunity for treatment for endometrial cancer patients. 

Katherine:

Well, you just mentioned clinical trials, and I think it’s a good topic to cover a little bit. Why is it important for patients to actually consider enrolling? What are the benefits for them? 

Dr. Ko:

Sure.

So, while we certainly have a good armamentarium of standard-of-care therapies already, and I should mention that does include our classic chemotherapy drugs like paclitaxel (Abraxane), carboplatin (Paraplatin), and even doxorubicin (Adriamycin), if you will, or doxorubicin Hcl (Doxil), there are the immunotherapy drugs now that have become standard of care as well, like pembrolizumab (Keytruda), but sometimes, despite using those best available drugs, the cancer unfortunately either continues to grow or you had a good response, but somehow it shows up again – the cancer shows up again – and so, then, we’re looking for additional opportunities, additional therapies. 

And so, some of the best opportunities are actually to consider these clinical trials. The way that clinical trials are designed is that they always are going  to provide you at least a backbone of a standard available therapy, so you’re never going to get less than what would be considered standard of care. 

But, what they’re doing is they’re usually partnering another drug – a more novel therapy – or they’re basically testing a more novel therapy that could be more targeted, that could potentially have better efficacy than what’s already available standardly. And so, the value of that is that you could have an opportunity to have a therapy that could work even better.  

When you’ve tried something already, unfortunately, the cancer has grown, there is still opportunity, and while you’re on a clinical trial, I think one of the huge benefits is it’s very regulated. You are monitored so closely because at the base of all of this is safety. There is never going to be a drug or therapy that’s going to be administered to a patient without ensuring that there’s absolute safety for that patient, and so, that’s a way that you really have opportunity to get more treatment that could really help your cancer condition and do it in a very, very safe, formal fashion. 

Katherine:

And ultimately help others as well, in the future.  

Dr. Ko:

Exactly, absolutely, because as you’re participating in this process – and, of course, it’s a voluntary process to participate on a clinical trial, so we so appreciate all the patients who, in the past, have participated and are willing to participate in the future, but allows us also to really gather a lot of information to really inform cancer treatment for all the patients coming down the road, and those could be anyone. They could be our neighbors, our friends, our own family members, and that could really be so helpful to everyone that’s going through this type of thing. 

Katherine:

Absolutely, yeah. I’d like to back up a bit and talk about what endometrial cancer is. It’s often referred to as uterine cancer. So, are they the same thing? Are these terms interchangeable? 

Dr. Ko:

Sure, it’s a great question. So, endometrial cancer refers to cancer that starts in what I call the lining of the uterine cavity. So, inside the uterus, there’s a uterine cavity, and there’s a tissue that coats that cavity, and that’s called the endometrium. So, endometrial cancer is basically when cancer cells start growing from that tissue. And, of course, since that exists in the uterus, of course, it’s considered uterine cancer, and we’re just being a little bit more specific when we say endometrial cancer. But, of course, endometrial cancer is the most common form of uterine cancer by far, so in some ways, it’s almost – it’s synonymous.  

Katherine:

How is endometrial cancer staged? 

Dr. Ko:

So, the most classic, rigorous way to stage endometrial cancer is through a surgical procedure. So, what that usually involves is it does include a hysterectomy, removing the uterus and the cervix, usually also includes removing the fallopian tubes and the ovaries. 

And, at the same time, the surgeon will do a very thorough assessment of the abdominal pelvic cavity, basically looking around all those areas to see if there’s any signs of visible disease, anything they can see that looks like it could be tumor deposits in the abdominal cavity. If anything is seen, those deposits will be removed and biopsied, so that’s part of the staging procedure. 

And additionally, it’s important to try to assess the lymph nodes, typically. So, there are lymph nodes in the pelvic area, and then, higher up along the aortic area, and so, there are different surgical techniques that we can use to basically test or sample some of those lymph nodes, be able to remove them, send them to the pathologist, look under the microscope to see if there are any microscopic cancer cells that have traveled to those lymph nodes. 

So, that is all part of a surgical procedure, and with all the information collected from those tissue samples that are removed from the body and sent to the pathologist, but the pathologist then reviews all of that under a microscope, and then can issue a very thorough report describing where the cancer cells are located, and by definition, where the cancer cells are located then defines what the stage is of the cancer. 

Katherine:

Can you give me an example? 

Dr. Ko:

Of course. So, for example, if the cancer cells are located only in the uterus, and they’re not found anywhere else, then that is a stage I. If the cancer cells have traveled to the cervix area specifically, this we call a cervical stroma, that becomes a stage II. If the cancer cells have, for example, traveled to the fallopian tubes, or the ovaries, or the lymph nodes, then that becomes a stage III, and there are sort of substages within those categories as well. 

Katherine:

But stage III would be the highest or most severe? 

Dr. Ko:

So, there’s stage III, and then there’s actually stage IV. So, if the cancer cells have traveled outside of the pelvis into the abdominal area, then we consider that a stage IV. 

Katherine:

And that would be considered advanced endometrial cancer? 

Dr. Ko:

Right. So, by definition, “advanced” typically refers to stage III or IV. 

Katherine:

I see, okay. Now that we understand more about the disease itself, I’d like to talk about the treatments that are currently available. You mentioned chemotherapy, but what else is available for people? 

Dr. Ko:

Absolutely. So, treatment for endometrial cancer is usually some combination of surgery, and then it may be followed by possibly chemotherapy, as well as radiation, and sometimes, it may be a combination of all three treatments, or sometimes, it’s a combination of one or two of those, depending on the exact stage, depending on the exact cell type, and some of the other factors. 

Katherine:

Are hormonal therapies used as well, and targeted therapies? 

Dr. Ko:

Yes. 

Katherine:

I know they are in other cancers. 

Dr. Ko:

Yes. And so, I think the question is where do those come into play? So, I would say the usual algorithm most commonly would be that surgery is done first, as the most common first step, and then, based on the information obtained from surgery and the pathology report that comes from that, then there’s usually some type of a recommendation about should there be a second stepped treatment, and that frequently can be chemotherapy/radiation.  

Now, the areas where targeted therapy – for example, immunotherapy – where does that come in? So, that now has come into the – I would call it the second stage. We’re combining it with the classic chemotherapy drugs – Taxol-carboplatin, for example. That’s one example where it could come into play. Another example could come into play where a patient had gone through classic Taxol/paclitaxel and carboplatin, then had cancer come back, and so, that could be another instance where that pembrolizumab or pembro with lenvatinib (Lenvima) combination can be used in the setting of recurrence. 

Now, we could also say, hey, if your cancer type has those hormonal receptors present or is some type of what we call endometrioid histology, and we think that hormonal therapy may be more effective in that case, then that could also be used in a setting where the cancer has kind of grown again, the cancer has grown back, or actually, there are certain situations where patients, for example, may not undergo a hysterectomy. 

And, there are unique cases and those situations where patients are still trying to preserve their fertility, and therefore not wanting to undergo a hysterectomy, or they’re unable to undergo surgery safely. And so, in some unique situations, we may also use hormonal therapy as the mechanism to treat their cancer, and whether that is by way of a pill, whether that is by way of a progesterone intrauterine device, IUD, that is placed into the uterus, we also have situations where we tailor the therapy to the condition of the patient. 

Katherine:

How are patients monitored for a recurrence, and are there approaches to help prevent a recurrence? 

Dr. Ko:

Sure, absolutely. Great question. It is important to continue monitoring patients, even after they’ve gone through treatment. So, I think of it as a multifaceted approach. Usually, it includes office visits, including a physical exam. It includes a thorough intake of all of their symptoms. 

It also includes – depending on the scenario – in some circumstances, regular imaging studies, such as a CT scan or MRI, and sometimes, we also do things like PET scans, and I think that does have to be tailored to the unique patient’s endometrial cancer, unique case, stage, histology, and we kind of tailor which tests we choose to do. The interval of monitoring can vary, so I would say generally speaking, it could be anywhere from three- to six-month visits, and with potentially added scans, as we talked about, and sometimes, we also do certain blood tests in certain cases where we may choose to follow a CA125 blood tumor marker. 

But, I would say that there are different, definitely variants to how we choose to monitor, and there are certain resources we tend to use, such as the NCCN guidelines that providers may reference, and sometimes may even share with the patients to explain why and how we choose to do the monitoring. 

Katherine:

When treating more advanced endometrial cancer disease in general, are the treatment options different than if you were treating somebody who had stage I or stage II, for instance? 

Dr. Ko:

Sure, great question. So, for some patients with, say, stage I, surgery alone is enough. 

For some other patients, subcategories of stage I, where we call them more high/intermediate-risk patients, they’re stage I, but there are a few features about their pathology that might make them slightly higher risk for recurrence – in those cases, we might consider a little bit of radiation after surgery, what we call adjuvant radiation or what we call radiation vaginal brachytherapy. Just three short treatments of a little bit of radiation to the top of the vagina has been shown to possibly decrease chance of recurrence in that area with very minimal side effects. 

So, that would be more commonly in line with stage I. There are some subtypes that can still be what we call high-risk, even in stage I/stage II uterine serous carcinoma, uterine carcinosarcoma. In those cases, we might also recommend chemotherapy along with some vaginal brachytherapy following their hysterectomy, so that’s the early stage. 

And then, with the advanced stage, yes. So, frequently, it’d be surgery first to secure the diagnosis, followed by some type of – it might be primarily chemotherapy, or it could be combination chemotherapy with radiation. And over time, I would say our paradigm for what we use for chemotherapy and radiation has changed a little bit. 

If you go back a couple decades, I think radiation was used a lot – whole pelvic radiation, even just without any chemotherapy. And then, we then had more data from research clinical trials, GOG-258 or PORTEC-3, that then had given us evidence that perhaps doing chemotherapy with some combination of radiation is going to be beneficial, or even moving towards primarily radiation could be a very good option in terms of long-term benefit/long-term survival. 

And, of course, that brings us to the present day, those two trials that I mentioned from ASCO, the GY018 and the RUBY, now bringing in the immunotherapy component to the chemotherapy, so there has definitely been an evolution to managing advanced stage. 

Katherine:

Yes. Dr. Ko, what goes into determining a treatment approach for an individual patient? Is there key testing that helps guide a patient’s prognosis and treatment options? 

Dr. Ko:

Absolutely. So, I think the key pieces of information come from several sources. First, we do take the whole patient into account, like baseline health, baseline function, meaning every day, how active are you? Are there limitations to your daily activities? Looking at baseline health conditions, what we call comorbidities. Are there other health conditions, like diabetes, heart conditions, lung condition, kidney conditions, that could really impact a patient’s overall health and wellbeing? That is always part of it, number one. 

Then, we look specific to the cancer details. So, from all the pathology information, biopsies, followed by a surgical staging procedure, what exact stage, what exact substage, and we might even look at other unique features. Was there cells that got into the lymph vessels, the lymph nodes? Are there other just features from a pathology standpoint that are important, like the – I talked about microsatellite status, microsatellite instable versus microsatellite stable. 

Those are all information we can gather from the tumor tissue itself. That then kind of tailors our therapy. And then, like I was saying, now we’re going into this molecular era where we can actually take that tumor tissue and even do more expanded testing on it. 

So, I think it’s worthwhile to talk to your provider and say, “Hey, would it be worthwhile to send my tumor out for expanded testing, whether it’s done at your institution, at a specialized lab, or whether it’s sent out to a company that does expanded testing?” Because then, they might be able to test for 500 different genetic signatures, a much more broad panel, but that might open the door for opportunities to say, “Hey, you actually do have a very unique signature, and maybe it is worth tailoring your therapy even further.” 

So, I think these are very important questions to have with your provider, and these pieces of information can help guide the prognosis. I think we’re always asking what does this mean long-term, and I think when we have all these individual pieces of information, we can then give guidance on that.  

Katherine:

Well, that leads me into my next question. I wanted to get your point of view on why is it important for patients to engage in their care and their treatment decisions? 

Dr. Ko:

Right. I think that it is so important. Medical treatments, I think, do work the best for the patient when the patient is truly an active participant, and what I mean by that is I think we can really understand the patient if there’s a conversation, there’s a mutual discussion, and I think every patient has unique circumstances, has unique goals, has…whether it’s just the daily whatever responsibilities, or just either health or non-health concerns that they have, we want to be able to find a treatment that fits the patient, and we realize that one treatment doesn’t fit all. 

And so, the more, I think, that there is this mutual discussion, mutual understanding, then there’s a mutual decision treatment plan that is made, and there’s the more ability to modify that plan when – if you realize, oh, maybe we can tailor it, maybe we try one thing, and maybe we realize we got to change a little bit.  

And, I think that with a cancer condition, it is a journey. It is not just a one-time thing. It really is a journey, and I think that the more a patient can participate throughout that journey, I think the better the outcomes for the patient, and honestly, the better the treatment course will be for everyone participating. 

Katherine:

Why should a patient consider finding an endometrial cancer specialist? What are the benefits? 

Dr. Ko:

So, I think naturally, an endometrial cancer specialist is a provider who spends more time thinking about the disease, reading about it, looking at what’s the newest research studies that are coming out, what are the available clinical trials here, locally, regionally, or nationally, what are other support services available for the patient in the space. 

And, of course, probably the folks that do the most surgeries gear towards endometrial cancer patients, and so, I think just working in that space naturally then brings more resources and more opportunity for the patient to kind of really know what’s out there, what is the newest, and I think that really benefits the patient. 

Katherine:

Thank you for sharing all this information. I’d like to close with your thoughts on the future of endometrial cancer care. Are you hopeful? 

Dr. Ko:

Yes. I think that I’m especially hopeful, especially within these last even few years, of where our field is going. I want to say I think there’s so much more that needs to be done.  

I don’t think we’re ready to close the books on endometrial cancer. I think this is just a wonderful opening of a chapter where we’re seeing many more therapies come about. I do think that something that is concerning is that we are seeing more cases of endometrial cancer being diagnosed – yeah, so it is absolutely true. There is very robust data that is collected by our CDC and cancer registry in the country, and it is showing that there is actually a rising incidence, that the number of endometrial cancer cases in this country is actually increasing over time, and it has – 

Katherine:

Why is that? 

Dr. Ko:

It’s a great question. 

Katherine:

Nobody knows – the data doesn’t include that information? 

Dr. Ko:

I think there’s definitely some information, there is definitely information out there. I think some of it – and this is not all of it – I think some of it is related to the increase in obesity and the increase in average weight over time, and this metabolic condition to some degree, I think, does stimulate potential risk for endometrial cancer. 

However, that is not the only reason, and what is concerning is that what we’re seeing is there’s a specific rise in subtypes of endometrial cancer in certain populations, particularly the Black and Hispanic patient populations, and we’re seeing a rise in the most aggressive types of endometrial cancer in those patient populations. I think there’s a lot of research going on right now in that to try to understand why. Is it just because we’re picking it up more? I don’t think that’s the bottom line. 

And, I think what we’re also realizing as we’re studying these various tumor types of endometrial cancer, they are driven by different biology. So, I think to some extent, the ones that are more maybe related to obesity or hormones and all may be slightly different – not completely separate, but that there is underlying different genetic basis for some of these cancers developing, and whether that’s a combination of underlying genes, environment, exposure, or all of the numerous factors, we just know it is happening, and so, it really is critical in my mind that the awareness and the focus and attention on endometrial cancers is really there, that we really think about it, that we share the information as much as possible, and that we can really then come to better – have more opportunity for treatments, be able to diagnose it sooner, be able to have more opportunities to treat it, and honestly, have better survival and outcomes for our patients. 

Katherine:

Dr. Ko, thank you so much for joining us today. You’ve given us so much information. 

Dr. Ko:

Thank you. It was my pleasure. 

Katherine:

And thank you to all of our collaborators. If you would like to watch this webinar again, there will be a replay available soon. You’ll receive an email when it’s ready. And don’t forget to take the survey immediately following this webinar. It will help us as we plan future programs. To learn more about endometrial cancer and to access tools to help you become a proactive patient, visit PowerfulPatients.org. I’m Katherine Banwell. Thanks for joining us.