In a patient with HER2+ advanced endometrial cancer, do you include IO(+/- olaparib) in their treatment regimen, or only trastuzumab in addition to carboplatin/paclitaxel?

Topics: Gynecologic Cancers • Endometrial Cancer • Medical Oncology • ASCO Journal Club • Journal Club ft. NEJM publications • Immune Checkpoint Inhibitor

Does your decision depend on MMR status? Would you use the same approach for neoadjuvant treatment?

In light of relevant trials including RUBY, GY018, DUO-E, and Fader et al., PMID 29584549.

Answer from: at Community Practice

This is a data-free zone and an excellent question. We don't yet know the efficacy of checkpoint inhibitor therapy in pMMR, HER2-positive, p53 mutated tumors, although the ad hoc RUBY data presented at ESMO suggest that p53 mutated tumors are responsive to immunotherapy. I eagerly await the histolog...

Comments

at Baptist Medical Group
Good point. What would you do if the tumor is dMM...

Answer from: at Academic Institution

In a patient with HER2+ advanced endometrial cancer, my first recommendation would be enrollment on GY-026, a randomized phase II/III trial comparing chemotherapy alone to chemotherapy plus trastuzumab or chemotherapy plus trastuzumab and pertuzumab. If trial enrollment was not a feasible option, tr...

Answer from: at Community Practice

The current published literature demonstrating the benefit of Trastuzumab added to chemo is based on a phase II trial only. The added benefit of IO to chemo is based on randomized phase III trials. Due to this, for now, I favor chemo/IO combination in this subset of the patients. I currently encoura...

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