The first 60 days: Advanced or recurrent endometrial cancer
Advanced or recurrent endometrial cancer has spread beyond the uterus or come back after treatment. Chemotherapy plus an immune checkpoint antibody is now the first treatment for everyone, with the biggest gains in mismatch-repair-deficient tumours, and lenvatinib with pembrolizumab is the standard when platinum chemotherapy stops working. Below, week by week, is what OnCo's record of Advanced or recurrent endometrial cancer says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- SurgeonNamed in the standard of care for: Isolated pelvic recurrence.
- Medical oncologistNamed in the standard of care for: First line, dMMR, First line, pMMR, After platinum, pMMR, After platinum, dMMR without prior immunotherapy and 1 more.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Isolated pelvic recurrence.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Carboplatin-paclitaxel with dostarlimab (RUBY) or pembrolizumab (NRG-GY018), then maintenance immunotherapy for up to three years or two years respectively.
Carboplatin-paclitaxel with pembrolizumab or dostarlimab, or durvalumab followed by durvalumab-olaparib maintenance (DUO-E); trastuzumab added for HER2-positive serous carcinoma.
Radiotherapy with brachytherapy for vaginal recurrence after surgery alone; exenteration in selected central recurrences after radiotherapy.
Lenvatinib with pembrolizumab (KEYNOTE-775); trastuzumab deruxtecan for HER2-expressing tumours; aromatase inhibitors or progestins for low-grade receptor-positive disease.
Single-agent dostarlimab or pembrolizumab.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example MMR and MSI status, p53 and POLE, HER2 immunohistochemistry, Oestrogen and progesterone receptors, PD-L1), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Primary stage III to IV endometrial cancer, First recurrence after surgery with or without adjuvant therapy, Mismatch-repair-deficient advanced disease.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
First line, dMMR
- For my situation (first line, dmmr), which of the standard options do you recommend and why?Guideline options include: Carboplatin-paclitaxel with dostarlimab (RUBY) or pembrolizumab (NRG-GY018), then maintenance immunotherapy for up to three years or two years respectively.
- Am I a candidate for Dostarlimab, Pembrolizumab, Carboplatin or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of RUBY / ENGOT-EN6 / GOG-3031 and NRG-GY018 / KEYNOTE-868 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
First line, pMMR
- For my situation (first line, pmmr), which of the standard options do you recommend and why?Guideline options include: Carboplatin-paclitaxel with pembrolizumab or dostarlimab, or durvalumab followed by durvalumab-olaparib maintenance (DUO-E); trastuzumab added for HER2-positive serous carcinoma.
- Am I a candidate for Pembrolizumab, Dostarlimab, Durvalumab or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of DUO-E / GOG-3041 / ENGOT-EN10 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
After platinum, pMMR
- For my situation (after platinum, pmmr), which of the standard options do you recommend and why?Guideline options include: Lenvatinib with pembrolizumab (KEYNOTE-775); trastuzumab deruxtecan for HER2-expressing tumours; aromatase inhibitors or progestins for low-grade receptor-positive disease.
- Am I a candidate for Lenvatinib, Pembrolizumab, Trastuzumab deruxtecan or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-775 / Study 309 and DESTINY-PanTumor02 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
After platinum, dMMR without prior immunotherapy
- For my situation (after platinum, dmmr without prior immunotherapy), which of the standard options do you recommend and why?Guideline options include: Single-agent dostarlimab or pembrolizumab.
- Am I a candidate for Dostarlimab, Pembrolizumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Isolated pelvic recurrence
- For my situation (isolated pelvic recurrence), which of the standard options do you recommend and why?Guideline options include: Radiotherapy with brachytherapy for vaginal recurrence after surgery alone; exenteration in selected central recurrences after radiotherapy.
Any stage
- Are there clinical trials I could join, for example of Sacituzumab tirumotecan, Rinatabart sesutecan, RAINFOL-01 (Rina-S), Trastuzumab deruxtecan?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “What to give after progression on first-line immunotherapy”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “The small benefit and real toxicity of immunotherapy in proficient tumours”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- DESTINY-Endometrial01: A Phase III Study of Trastuzumab Deruxtecan Plus Rilvegostomig or Pembrolizumab as First-Line Treatment of HER2-Expressing (IHCPhase 3 · recruiting · NCT06989112DESTINY-Endometrial01: An Open-Label, Sponsor-Blinded, Randomized, Controlled, Multicenter, Phase III Study of Trastuzumab Deruxtecan (T-DXd) Plus Rilvegostomig or Pembrolizumab vs Chemotherapy Plus Pembrolizumab as First-Line Therapy of HER2-Expressing (IHC 3+/2+), Mismatch Repair Proficient (pMMR), Primary Advanced or Recurrent Endometrial Cancer
- Study of Pembrolizumab (MK-3475) Versus Chemotherapy in Mismatch Repair Deficient (dMMR) Advanced or Recurrent Endometrial Carcinoma (MK-3475-C93/KEYNOTE-C93/GOG-3064/ENGOT-en15)Phase 3 · active · NCT05173987A Phase 3 Randomized, Open-label, Active-comparator Controlled Clinical Study of Pembrolizumab Versus Platinum Doublet Chemotherapy in Participants With Mismatch Repair Deficient (dMMR) Advanced or Recurrent Endometrial Carcinoma in the First-line Setting (KEYNOTE-C93/GOG-3064/ENGOT-en15)
- RAINFOL-01 (Rina-S)Phase 1/2 · active · NCT05579366Advanced ovarian and endometrial cancer, heavily pretreated: rinatabart sesutecan (FRα ADC, exatecan payload) across FRα expression levels
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Advanced or recurrent endometrial cancer: the full pageAdvanced or recurrent endometrial cancer has spread beyond the uterus or come back after treatment. Chemotherapy plus an immune checkpoint antibody is now the first treatment for everyone, with the biggest gains in mismatch-repair-deficient tumours, and lenvatinib with pembrolizumab is the standard when platinum chemotherapy stops working.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Radiotherapy: Using high-energy X-rays or particles to damage the DNA of cancer cells in a precisely aimed volume of the body.
- Microsatellite-stable (MSS) / mismatch-repair proficient (pMMR): The 'normal' result on the mismatch-repair test: the tumour has intact DNA spell-checking and few mutations.
- Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR): Microsatellite instability is the mark of a broken DNA spell-checker (loss of MLH1, MSH2, MSH6 or PMS2) that leaves thousands of mutations, so the tumour displays abnormal proteins that T cells can recognise.
Every term links to the glossary.