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Would you recommend adjuvant chemo+IO +/- olaparib for patients with occult stage III disease identified after staging surgery with no measurable residual disease?

DUO-E, GY-018, and RUBY included patients with stage III and IV endometrial cancer WITH measurable disease. Would your decision change based on the mismatch repair status of the tumor?
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Given results of DUO-E, GY-018 and RUBY, would you prescribe adjuvant immune checkpoint inhibitor + chemotherapy for patients with occult stage III disease identified after staging surgery with no gross residual disease?

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4 Answers
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Gynecologic Oncology · University of Alabama at Birmingham
Answered on

Although most of those patients were not included in the trial, it is definitely a discussion I would have for patients with MMRd tumors and would recommend it to them.

I would for MMRd patients although they were not included in the trial if they had stage 3 endometrioid histology. More data on thi...

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Gynecologic Oncology · UCSD Moores Cancer Center
Answered on

This is an important and relevant question. The strength of the GY-018 and RUBY trials lies in the consistency of the data, informing the benefit of adding ICI to chemotherapy and then as maintenance. This benefit was dramatic in the dMMR cohort (essentially identical HR of 0.30/0.28). In the dMMR p...

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Gynecologic Oncology · Alliance Cancer Specialists, PC
Answered on

At this time I believe it is premature to change adjuvant chemo + /- RT to adjuvant chemo +/- IO. As mentioned, none of the phase III trials DUO-E, GY018, and RUBY included stage III disease without measurable disease. We don’t have any randomized trials in this setting to answer the question and he...

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Gynecologic Oncology · University of Iowa
Answered on

The recent results from GY018, RUBY, and DUO-E have changed the landscape in how we treat our advanced endometrial cancer patients. All three trials have shown improved progression free survival in patients receiving immunotherapy +/- olaparib in combination with and following standard-of-care chemo...

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