POLE-ultramutated endometrial cancer
Prepared with OnCo (onco.cc/prep/endometrial-pole-ultramutated/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
17 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example POLE exonuclease domain sequencing, Tumour mutational burden above 100 mutations per megabase, p53 and MMR immunohistochemistry, Tumour-infiltrating lymphocytes, Stage and lymphovascular space invasion), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (diagnosis and classification), which of the standard options do you recommend and why?
- 6.How do the results of FIRES & SENTOR (sentinel node mapping) apply to someone like me?
- 7.For my situation (stage i to ii after surgery), which of the standard options do you recommend and why?
- 8.For my situation (stage iii after surgery), which of the standard options do you recommend and why?
- 9.Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, and what side effects should I expect?
- 10.How do the results of PORTEC-3 apply to someone like me?
- 11.For my situation (advanced or recurrent (rare)), which of the standard options do you recommend and why?
- 12.Am I a candidate for Pembrolizumab, Dostarlimab, and what side effects should I expect?
- 13.Are there clinical trials I could join, for example of Molecular-class-directed adjuvant therapy in endometrial cancer, Endometrial cancer molecular classes (POLEmut, MMRd, p53abn, NSMP), MRD / molecular residual disease testing?
- 14.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 15.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 16.I read that “Deciding which non-hotspot POLE variants are pathogenic”. How does that affect my plan?
- 17.I read that “Whether stage III and IV disease can also be de-escalated”. How does that affect my plan?
The words I may hear
- Next-generation sequencing (NGS): Reading millions of DNA fragments in parallel, the engine behind every modern genomic test.
- Endometrial cancer molecular classes (POLEmut, MMRd, p53abn, NSMP): Four groups defined by a few tests that predict outcome better than the microscope: POLE-mutated (excellent), mismatch-repair deficient, p53-abnormal (worst), and 'no specific profile'.
- Hysterectomy: Removing the uterus (womb), often with the cervix, tubes and ovaries.
Tests and results to bring
Diagnosis and classification: Hysterectomy with bilateral salpingo-oophorectomy and sentinel node mapping; molecular classification of every endometrial cancer with POLE sequencing, MMR and p53 immunohistochemistry.
Biomarker results to ask for: POLE exonuclease domain sequencing (first step of the ProMisE classifier), Tumour mutational burden above 100 mutations per megabase, p53 and MMR immunohistochemistry (interpreted after POLE), Tumour-infiltrating lymphocytes, Stage and lymphovascular space invasion.
Scans and tests linked to this cancer: Histopathology & immunohistochemistry, MRD / molecular residual disease testing.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Stage I to II after surgery: Observation without adjuvant treatment is acceptable under the ESGO/ESTRO/ESP guideline; vaginal brachytherapy where local protocol still requires it. (Brachytherapy, Endometrial cancer molecular classes (POLEmut, MMRd, p53abn, NSMP), Molecular-class-directed adjuvant therapy in endometrial cancer)
- Stage III after surgery: Pelvic radiotherapy without chemotherapy, as in RAINBO POLEmut-BLUE; chemoradiation with chemotherapy remains an option outside trials. (IMRT / IGRT (modern external beam), PORTEC-3, Carboplatin, Paclitaxel / nab-paclitaxel)
- Advanced or recurrent (rare): Checkpoint inhibitor with or without chemotherapy by extrapolation from the mismatch-repair-deficient class. (Pembrolizumab, Dostarlimab, Immune checkpoint inhibitors)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.