Treatment options for molecular subtypes of endometrial cancer in 2023.
Journal
Current opinion in obstetrics & gynecology
ISSN: 1473-656X
Titre abrégé: Curr Opin Obstet Gynecol
Pays: England
ID NLM: 9007264
Informations de publication
Date de publication:
01 06 2023
01 06 2023
Historique:
medline:
17
5
2023
pubmed:
22
3
2023
entrez:
21
3
2023
Statut:
ppublish
Résumé
This article reviews treatment strategies in endometrial cancer by molecular subtype. The Cancer Genome Atlas (TCGA) classifies four molecular subtypes of endometrial cancer - mismatch repair-deficient (dMMR)/microsatellite instability-high (MSI-H), copy number high (CNH)/p53abn, copy number low (CNL)/no specific molecular profile (NSMP), and POLEmut - which are validated and highly prognostic. Treatment consideration by subtype is now recommended. FDA-approved immune checkpoint inhibitors (ICIs) include pembrolizumab and dostarlimab for previously treated dMMR/MSI-H EC, and pembrolizumab/lenvatinib for mismatch repair-proficient/microsatellite-stable endometrial cancer, including CNH/p53abn and CNL/NSMP. ICIs are being studied as first-line therapy in advanced/recurrent endometrial cancer by MMR status, as well as in combination with other targeted agents. Trastuzumab is NCCN compendium listed for HER2-positive serous endometrial cancer, which are primarily p53-abnormal. Antibody-drug conjugates targeting low and high HER2 levels show promise in breast cancer, and are beginning to be studied in endometrial cancer. In addition to hormonal therapy, maintenance therapy with selinexor (XPO1-inhibitor) showed potential benefit in p53 -wildtype endometrial cancer and is being investigated prospectively. Multiple prospective trials are evaluating de-escalation of care for POLEmut endometrial cancer given favorable survival regardless of adjuvant therapy. Molecular subtyping has important prognostic and therapeutic implications and should be guiding patient management and clinical trial design in endometrial cancer.
Identifiants
pubmed: 36943683
doi: 10.1097/GCO.0000000000000855
pii: 00001703-202306000-00014
doi:
Substances chimiques
Tumor Suppressor Protein p53
0
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
270-278Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
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