Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment

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What are endometrial cancer biomarkers? Dr. Hinchcliff discusses how prognostic biomarkers, namely mismatch repair status and HER2, influence treatment, leading to more tailored strategies for patients.  

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

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Transcript: 

Katherine Banwell: 

Are there prognostic biomarkers that help determine how the cancer may behave? 

Dr. Emily Hinchcliff:  

Yeah. So, endometrial cancer, we now know that the molecular mechanism – so, what I’ve been talking about, these things that are happening inside the cancer cell – we now know that that can drive prognosis, and so, it used to be that we kind of had two big buckets of cancer. 

We used to say there’s Type 1 endometrial cancer and Type 2 endometrial cancer, and now, we’ve actually broken it down into molecular categories – so, into categories much more based on certainly what the cell looks like under the microscope, but also what’s going on inside the cell, not only to impact treatment, but also to give a patient a better look at what their prognosis is expected to potentially be, and we actually have changed our staging system pretty recently to incorporate some of those molecular characteristics that we now know to check for.  

Katherine Banwell:  

Talking about the biomarkers, how do biomarkers impact endometrial cancer treatment options? 

Dr. Emily Hinchcliff:  

Yeah, so I think specifically the two that I mentioned, the mismatch repair status and the HER2 status, have really robust data that tells us that we can better tailor our treatment strategy based on a patient’s status. So, for mismatch repair, for example, if someone is mismatch repair deficient, that tumor is going to respond very well, incredibly well, to immunotherapy. So, we now actually use immunotherapy in combination with chemotherapy to treat those cancers, especially for the cancers that have spread outside the uterus or the cancers that have gone through initial treatment and then come back. 

So, I think that is a really great option. Similarly, that HER2 receptor, there is a medicine that targets that receptor, which is that cell surface molecule, that thing that’s sitting on the cancer surface, and can treat that cancer better if that marker is expressed. 

What Questions Should Patients Ask About Endometrial Cancer Testing?

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What questions should patients ask about endometrial cancer testing? Dr. Hinchcliff highlights key questions, while stressing the importance of understanding both germline and somatic tests and their impact on treatment. She emphasizes the value of open, ongoing communication with doctors.  

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

Download Resource Guide

See More from INSIST! Endometrial Cancer

Related Resources:

Essential Endometrial Cancer Testing

Essential Endometrial Cancer Testing

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Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment

 Endometrial Cancer | What Is Personalized Medicine?

Endometrial Cancer | What Is Personalized Medicine?

Transcript: 

Katherine Banwell:  

Right. And so, what questions should patients ask about their test results? 

Dr. Emily Hinchcliff:  

Yeah, so, I think first and foremost, just getting an understanding of what tests your doctor is sending is really important. This should be an open conversation, and it’s a conversation that you should actually have as you are going throughout your cancer journey. It’s not just a conversation at your diagnosis, it’s something that, if your cancer comes back, it should be reassessed. Are there additional markers that we should send that we didn’t send in the upfront setting? Do we have a complete picture of my cancer? 

And so, I think that is definitely a question to ask, is what tests are you sending, and what is the outcome of those tests, right? How would that test change your potential management or change the options that you have for me in terms of my cancer treatment? The other thing that I will say that I think can be confusing for patients as we think about the genomics and genetics of a cancer is that it’s really important to understand the difference between something called germline and something called somatic testing, and so, I’m going to explain that, because I think it can be confusing. 

The first, germline, is a test that is testing the genetics of the whole body – so, of a person – to see if there’s anything that’s hereditary that might have predisposed them to getting cancer. And so, that is something that, if it is abnormal, it may mean that family members need to get tested, and there are things that we can do to try and prevent cancers for other people in your family that might be at risk. So, that is germline testing. 

That’s different than somatic testing. Somatic testing is when we test the tumor itself to understand what about this tumor allowed it to become abnormal, allowed it to grow abnormally and keep growing the way cancer does? And both of those are really important. So, I think as you ask your doctor, “What tests are you sending?”, it’s important to ask about tests in both of those categories. 

Essential Endometrial Cancer Testing

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What testing should endometrial cancer patients undergo after diagnosis? Dr. Hinchcliff explains the importance of determining cancer stage, histology, and performing biomarker testing, as these factors can guide more targeted treatments.

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

Download Resource Guide

See More from INSIST! Endometrial Cancer

Related Resources:

What Questions Should Patients Ask About Endometrial Cancer Testing?What Questions Should Patients Ask About Endometrial Cancer Testing? Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment

Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment

 Endometrial Cancer | What Is Personalized Medicine?

Endometrial Cancer | What Is Personalized Medicine?

Transcript: 

Katherine Banwell:   

Dr. Hinchcliff, what testing should people with endometrial cancer undergo after diagnosis? 

Dr. Emily Hinchcliff:  

So, when I think about a cancer diagnosis, there are first two big buckets of things that are important to understand. One is the cancer stage, meaning where did the cancer start, and then, where has it potentially spread to. The other is the cancer histology, or what do the cells look like under the microscope. And in endometrial cancer, there are actually a variety of different subtypes of endometrial cancer that can be differentiated based on what they look like under the microscope. Once you have those as your framework, I think the next step is to better understand what’s called biomarker testing, or the genetics of your cancer. 

Katherine Banwell:  

Would you define biomarker testing? What does that mean? 

Dr. Emily Hinchcliff:  

Yeah. So, biomarker testing – while, under the microscope, we can determine what kind of cancer something is, we can’t tell what’s going on inside the cancer cells itself, and so, biomarker testing is an umbrella term for a variety of different tests that really try and assess what’s going on inside the cancer, what are the genetics making the cancer cells divide and grow abnormally, and also, what are the things that might be expressed or on the cancer cell surface that are potentially targets for us to leverage to treat the cancer better. So, what is unique to that cancer, either the patient’s own cancer individually or that cancer type in general, that we can use to our benefit to treat the cancer better.  

Katherine Banwell:  

What are the most common biomarkers associated with gynecologic cancers?  

Dr. Emily Hinchcliff:  

So, in endometrial cancer specifically, I think if there are a couple take-homes that I can emphasize to patients in this talk today, the first is it is essential to know your what’s called mismatch repair status. So, mismatch repair is one of the things that can happen inside a cancer cell, and when that goes awry, when that becomes abnormal, it means that the cancer has particular features that we can use to treat it better. 

And so, the two categories of mismatch repair are you can be mismatch repair deficient, meaning there’s something abnormal in that machinery inside the cancer cell, or mismatch repair proficient, meaning that that machinery is still intact, and the reason for that being so important is that in endometrial cancer, if someone’s cancer is mismatch repair deficient, we can use a whole class of drugs called immunotherapy, or leveraging your own immune system using medicines to try and treat that cancer better. 

So, I think knowing that about your cancer type is really essential in endometrial cancer. I think the other thing that is important to know is in endometrial cancer, some subsets will express a receptor – so basically, something on the cancer surface – called HER2, and if you are HER2-positive, that also can be a target for potential drugs. So, those are two really important biomarkers in endometrial cancer that I think it’s important that patients know that they have been tested, and then know what their results are.