June 4, 2024
By Catlin Nalley
A recent research effort aimed to better understand the treatment approaches taken by health care providers for the management of advanced endometrial cancer, and how they aligned with current expert recommendations. Findings from this analysis were presented during the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 5613).
“Practice patterns are rapidly evolving for first-line treatment of advanced endometrial cancer. In 2022, we created an online interactive decision support tool for health care professionals with case-specific recommendations from five gynecologic oncology experts for treating first-line and second-line advanced endometrial cancer,” noted study author Ritu Salani, MD, Director of Gynecologic Oncology in the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues.
“In 2023, NCCN guidelines included a recommendation of carboplatin/paclitaxel plus an immune checkpoint inhibitor for first-line treatment of advanced endometrial cancer. Working with the experts, we updated the tool to its current 2023 version,” the researchers stated. “Here, we compare planned treatment reported by health care providers using the 2023 tool versus expert recommendations and compare practice patterns for the 2023 versus 2022 tools.”
To use the current version of the online interactive decision support tool (clinicaloptions.com/Endometrialtool), health care provides entered key characteristics. This included treatment setting; tumor histology (first-line only); actionable biomarker status (dMMR/MSI-H, HER2, ER/PgR); prior treatment, response, and response duration (second-line only); and planned treatment.
Once health care providers shared their treatment plan, the tool provided expert recommendations for that scenario and prompted health care professionals to consider if the recommendations changed their planned treatment approach.
From September 2023 to January 2024, 123 health care providers entered 181 cases into the support tool. Of those cases, 45 percent were in the first-line setting. A biomarker status of “unknown” was reported by health care providers in 30 percent of first-line cases, according to the research team.
“In 2022, all experts recommended platinum-based chemotherapy with or without bevacizumab for first-line HER2-negative cases, whereas all experts in 2023 recommended platinum-based chemotherapy plus immune checkpoint inhibitor for first-line cases with dMMR/MSI-H,” Salani and colleagues reported.
“There was less consensus on adding immune checkpoint inhibitor to platinum-based chemotherapy when first-line cases had no actionable biomarker,” they noted. “In 2023, the treatment planned by health care professionals matched ≥1 expert in 29 of 54 (54%) first-line cases—a modest improvement from 2022, when matches occurred in 19 of 42 (45%) first-line cases. In 2023, match rates were highest for dMMR/MSI-H cases (50%-86%), followed by cases without actionable biomarker (36%-50%) or HER2+ (33%-67%).”
Overall, the data showed that 88 percent of health care professionals indicated that the tool recommendations either changed or confirmed their treatment plan. “Health care professionals are challenged to optimally manage first-line advanced endometrial cancer in concordance with expert recommendations and/or NCCN guidelines,” concluded Salani and colleagues.