Advances in Endometrial Cancer Treatment & Research: What Patients Should Know

Katherine Banwell:

Dr. Roque, what are the recent advances in endometrial cancer care that patients should know about?

Dr. Dario Roque:

Yes, I think we can divide those into probably two categories. So, in the category of surgical management, we can think of what I call sentinel lymph node biopsies. So, historically, when we stage endometrial cancer, we remove some of the lymph nodes as part of the surgery to help us determine if the cancer has spread to the lymph nodes. And that is how we determine the stage of the cancer. So, historically, we would do what’s called a full pelvic and periaortic lymphadenectomy, which is removing lymph nodes from certain anatomical spaces in the body.

Over the last few years, we have been doing more targeted removal of what I call sentinel lymph nodes, which are, by definition, the first lymph nodes where the cancer will travel to if it leaves the uterus. So, the surgery is a little bit more forgiving on the body, has less side effects such as lymphedema. So, I think that has been a great advancement and benefit for the patient. Where I think the majority of the advances have been are in the chemotherapy or systemic therapy…let me rephrase that. Where I think most of the advances have been are in the systemic therapy aspect of the management of endometrial cancer, primarily with immunotherapy and some of the newer drugs that have been approved in this space.

In terms of immunotherapy, there are two drugs right now that we use in the frontline setting.

Meaning like, as a first line of treatment for patients with advanced or recurring endometrial cancer. Those drugs, one of them is called Jemperli or dostarlimab-gxly. The other one is called Keytruda or pembrolizumab. So, that has truly revolutionized the way we care for patients, and some of the benefits in terms of survival that we’re seeing, especially in patients that have what is called mismatch repair deficiency in the tumor. That is a molecular marker that we routinely test for in patients that are positive for the marker of a truly remarkable response to these drugs even in the setting of advanced or recurrent disease.

And then more recently, over the last couple of years, there have been newer drugs that have been approved. One of them is called Enhertu, so that’s a drug; it’s called an antibody drug conjugate that has a tremendous benefit with response rates in the 40 percent range for patients that have a specific marker in their endometrial cancer cells.

And that marker is called HER2.

Katherine Banwell:

All right. How are these new therapies improving outcomes for patients?

Dr. Dario Roque:

Yeah, so usually we think about the benefits of these therapies when we think about survival outcomes. So, that could be what’s called progression-free survival, meaning how long until the cancer comes back after the patient has started treatment, but it can also mean what’s called overall survival. That means how long are patients living with cancer. And both of these therapies have shown significant benefit in that progression-free survival space. One of the therapies, specifically Jemperli, has shown benefit in terms of overall survival.

So, essentially, we’re helping patients live longer before either the cancer comes back or, in some instances, the cancer is not returning at all. So, for some of these patients, we can almost consider them to be in full remission or a cure, which is truly remarkable considering that just a few years ago, patients with endometrial cancer that had advanced-stage disease or recurrent disease, it was not something that was considered curable.

This is not the case for all patients, but I do think that there is a significant portion of patients that are able to derive significant benefit from these treatments.