OnCo

Endometrial cancer: lines of therapy

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12 standard-of-care settings across 6 lines and 5 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

LineAll comersHER2MSI-H / dMMRpMMR / MSSRisk group
Screening, prevention and diagnosis2····
Early / localised2···1
Locally advanced····1
Second line2·11·
Special situations1····
Other settings·1···

Screening, prevention and diagnosis

SubgroupSettingApproachProducts and trialsEvidence
All comersPrevention and hereditary riskUniversal MMR testing of tumours to identify Lynch syndrome; risk-reducing hysterectomy and salpingo-oophorectomy for Lynch carriers after childbearing; levonorgestrel IUD and weight management reduce risk; no screening for average-risk women.40
All comersDiagnosis and stagingEndometrial biopsy for postmenopausal bleeding; MRI for myometrial and cervical invasion; molecular classification (p53, MMR IHC, POLE sequencing) on the diagnostic specimen.40

Early / localised

SubgroupSettingApproachProducts and trialsEvidence
All comersEarlyHysterectomy; adjuvant therapy by molecular class.
All comersEarly stage surgeryMinimally invasive total hysterectomy and bilateral salpingo-oophorectomy with sentinel lymph node mapping (FIRES, SENTOR); omentectomy for serous histology.68
Risk groupAdjuvant, low and intermediate riskObservation (low risk, POLEmut) or vaginal brachytherapy (intermediate risk; PORTEC-2); molecular class may de-escalate (PORTEC-4a).40

Locally advanced

SubgroupSettingApproachProducts and trialsEvidence
Risk groupAdjuvant, high risk (stage III, serous, p53abn, deep invasion grade 3)Chemoradiation plus carboplatin-paclitaxel (PORTEC-3) or chemotherapy alone (GOG-258); pembrolizumab or dostarlimab added for stage III-IV per RUBY/GY018 eligibility.98

Second line

SubgroupSettingApproachProducts and trialsEvidence
All comersAdvanced/recurrentChemotherapy + dostarlimab or pembrolizumab; lenvatinib-pembrolizumab; T-DXd if HER2+.98
All comersAdvanced or recurrent, first line (any MMR status)Carboplatin-paclitaxel plus dostarlimab (RUBY), pembrolizumab (NRG-GY018/KEYNOTE-868), or durvalumab (DUO-E; dMMR in the US), continued as maintenance up to 2-3 years.98
MSI-H / dMMRRecurrent, dMMR, after chemotherapySingle-agent PD-1 blockade (dostarlimab GARNET, pembrolizumab) if immunotherapy-naive; otherwise chemotherapy or trials.98
pMMR / MSSRecurrent, pMMR, after platinumLenvatinib + pembrolizumab (KEYNOTE-775) if not previously given immunotherapy; T-DXd if HER2 IHC 3+; chemotherapy (doxorubicin, weekly paclitaxel); hormonal therapy for low-grade ER-positive disease.98

Special situations

SubgroupSettingApproachProducts and trialsEvidence
All comersFertility-sparing (grade 1, stage IA, no invasion)Progestin (oral or IUD) with re-biopsy every 3-6 months; hysterectomy after childbearing.55

Other settings

SubgroupSettingApproachProducts and trialsEvidence
HER2HER2-positive serousTrastuzumab with carboplatin-paclitaxel (randomised phase 2) or T-DXd for IHC 3+ after prior therapy.97

Sequence and caution pairings

Regimens in the library

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.