If a patient with recurrent endometrial cancer experiences minimal or slow disease progression on pembrolizumab or pembro/lenvatinib, would you consider continuing or would you change agents?

Great question with unfortunately no perfect answer. There are several things that need to be considered if there is slow or minimal progression.

1. Is this true progression (patient is on immunotherapy)?
2. How well is the patient tolerating the therapy (are toxicities worth the benefit in this patient)?
3. What is the patient's overall disease burden and how clinically significant is the progression?
4. Do you have any other options (a trial, for example)?
5. Goals of care of the patient. If you are using it first line then you may have other treatment options. If you are 2nd or 3rd line, you may be willing to accept minimal progression if their quality of life is good.
6. Financial implications (len/pem or pem is costly).