Evolving treatment paradigms in metastatic or recurrent low-grade endometrial cancer: When is hormonal-based therapy the preferred option?

Endometrial cancer is the most common gynecologic malignancy in developed countries, with increasing incidence and mortality rates worldwide. While most cases are successfully treated with surgery, first-line treatment options for metastatic or recurrent endometrial cancer involve significant toxicities. Imprecise classification of heterogeneous subgroups further complicates treatment decisions and interpretation of clinical trial results. Recent advances in molecular classification are guiding treatment decisions for metastatic or recurrent endometrial cancers. Integrating molecular characteristics with traditional clinicopathology can both reduce overtreatment or undertreatment and help guide the appropriate choice of therapies and effective design of future studies. Here we discuss the treatment of metastatic or recurrent low-grade endometrioid adenocarcinoma of the uterine corpus, which is distinct from high-grade tumors histologically, molecularly, and in treatment response.
Competing Interests: Competing interests: The authors disclose the following potential conflicts of interest: IRC: Grants or contracts from any entity: MSD, Roche, BMS, Novartis, AstraZeneca, Merck Sereno; Consulting Fees: Abbvie, Agenus, Advaxis, BMS, PharmaMar, Genmab, Pfizer, AstraZeneca, Roche, GSK, MSD, Deciphera, Mersena, Merck Sereno, Novartis, Amgen, Tesaro and Clovis, Adaptimmun, DAICHI Sankyo, ESAI, Immunogen, Seagen, Blueprint, Takeda, Chugai; Travel Support: Roche, AstraZeneca, MSD, ESAI, GSK; Participation on a Data Safety Monitoring Board or Advisory Board: Athena, ATTEND, AGOOVAR57; MITO25; Leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid: Chair GINECO. DL: Consulting Fees: AstraZeneca, Clovis Oncology, GSK, MSD, Immunogen, Genmab, Seagen, Novartis, PharmaMar; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events: AstraZeneca, Clovis Oncology, GSK, MSD, PharmaMar; Payment for expert testimony: Clovis Oncology; Support for attending meetings and/or travel: AstraZeneca, Clovis Oncology, GSK; Participation on a Data Safety Monitoring Board or Advisory Board: Seagen, Immunogen, Genmab, Oncoinvest, Corcept, Sutro, AstraZeneca, GSK; Leadership or fiduciary role in other board, society, committee, or advocacy group, unpaid: GCIG, Member, Board of Directors; Receipt of equipment, materials, drugs, medical writing, gifts, or other services (payments made to institution): Clovis Oncology, GSK, MSD, PharmaMar; Institutional funding for work in clinical trials: AstraZeneca, Clovis Oncology, GSK, MSD, Genmab, PharmaMar, Seagen, Immunogen, Novartis, Roche, Incyte. BJM: Consulting Fees: Acrivon, Adaptimune, Agenus, Akeso Bio, Amgen, Aravive, AstraZeneca, Bayer, Clovis, Easai, Elevar, EMD Merck, Genmab/Seagen, GOG Foundation, Gradalis, Heng Rui, ImmunoGen, Karyopharm, Iovance, Laekna, Macrogenics, Merck, Mersana, Myriad, Novartis, Novocure, OncoC4, Panavance, Pieris, Pfizer, Puma, Regeneron, Roche/Genentech, Sorrento, TESARO/GSK, US Oncology Research, VBL, Verastem, Zentalis; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events: AstraZeneca, Easai, Myriad, Roche/Genentech, TESARO/GSK. BS: Consulting Fees: AstraZeneca, Clovis, GSK, Genentech, Lilly, Novartis, Gilead, Seagen, Karyopharm, Addy, Circulogene, GOG Foundation, Merck, Imvax, EQRx, Nuvation; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events: Seagen. The remaining authors declare no conflicts of interest.
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