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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?

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.
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Would you prescribe adjuvant chemotherapy with immunotherapy or trastuzumab + maintenance therapy for a patient with advanced stage endometrial cancer whose tumor is pMMR and HER2+?

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3 Answers
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Gynecologic Oncology · Johns Hopkins Medicine - Green Spring Station
Answered on

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...

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Gynecologic Oncology · University of Iowa
Answered on

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...

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Gynecologic Oncology · Alliance Cancer Specialists, PC
Answered on

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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