Immunotherapy is indicated for patients proficient in MMR. Lenvatinib plus pembrolizumab was demonstrated to have antitumor activity in patients with advanced endometrial carcinoma who have experienced disease progression after systemic therapy, regardless of tumor MSI status. This combination therapy was approved by the FDA in July 2021 for patients with advanced endometrial carcinoma that is not MSI-H or dMMR.
Hormonal therapy is typically used for lower-grade endometroid histologies, preferably with small tumor volume or slow growth. The main predictors of response to hormonal therapy in the context of metastatic disease are well-differentiated tumors, expression of ER/PR receptors, a long disease-free interval, and the location and extent of extrapelvic metastases. For asymptomatic or low-grade disseminated metastases, hormonal therapy with pro-gestational agents has been associated with good responses, especially among cancers which are ER- or PR-positive.
Chemotherapy for endometrial cancer has been thoroughly studied. Multiagent chemotherapy regimens are preferred for many cases of metastatic, recurrent, or high-risk disease in patients who can tolerate them, though single-agent therapy can also be used if needed.
For patients who have only undergone brachytherapy, for those with no RT exposure at the recurrence site, the NCCN suggests either RT plus brachytherapy or surgery. Of note, after patients have undergone RT, the incidence of recurrences confined to the pelvis is infrequent. But for isolated recurrences confined to the vagina or the pelvis alone, second-line treatment (typically with RT and/or surgery or systemic therapy) can be effective.
For patients with persistent progression, the NCCN recommends enrollment in a clinical trial.
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Cite this: Pamela Soliman. Skill Checkup: A Woman With Increasing Abdominal Pain, Nausea, Vomiting, and Ascites - Medscape - Apr 21, 2022.