I went to the endometrial cancer presentation which focused on optimizing outcomes and quality of life for patients with endometrial cancer through advances in molecular testing, treatment strategies, and toxicity management. One of the major themes was the importance of molecular classification and guiding treatment discussions. Endometrial cancers can be classified into molecular subgroups, including POLE-mutated, mismatch repair-deficient, no specific molecular profile, and p53-abnormal tumors.
Universal mismatch repair or microsatellite instability testing is important for identifying patients who may benefit from immunotherapy and for recognizing potential Lynch syndrome. HER2 testing can also help to identify patients who may benefit from targeted treatment in appropriate clinical settings.
Another key focus was the evolving role of immunotherapy in advanced and recurrent endometrial cancer. Trials like RUBY-1, KEYNOTE-888 and DUO-E have demonstrated the benefits of incorporating immunotherapy into treatment regimens, especially for patients with mismatch repair-deficient disease, although patients with MSI-stable disease also had meaningful benefits.
The presentation highlighted the 4-year RUBY results which showed sustained improvements in progression-free survival and overall survival with dostarlimab plus chemo compared to chemo alone in patients with mismatch repair-deficient tumors. Additional treatment options discussed included pembrolizumab plus lenvatinib for previously treated mismatch repair-proficient disease and trastuzumab deruxtecan for selected HER2-expressing tumors.
The final section discussed recognizing and managing adverse events, including immune-mediated toxicities, lenvatinib-associated hypertension and GI side effects, and the risk of ILD with trastuzumab deruxtecan. One of the most interesting takeaways for me was how significantly molecular profiling has changed the treatment landscape for endometrial cancer and how we can increasingly tailor treatment based on the tumor's molecular characteristics. I was particularly interested in the sustained benefit of immunotherapy in patients with mismatch repair-deficient tumors as seen by the long-term RUBY results. This reinforces the importance of identifying biomarkers early because the results of molecular testing can directly influence treatment selection and patient outcomes.
For advanced practitioners, these advances reinforce our role in coordinating care, educating patients, monitoring treatment response, and identifying toxicities early. We need to ensure that appropriate biomarker testing is completed and reviewed before treatment decisions are finalized, collaborating with our physician colleagues. Second, proactive side effect management is critical with immunotherapy. We need to educate patients about immune-mediated side effects like diarrhea or colitis, cough or shortness of breath, or symptoms of endocrinopathies. For patients receiving lenvatinib, we want to monitor blood pressure and monitor for GI adverse events. And with trastuzumab deruxtecan, we need to recognize new respiratory symptoms promptly because of the risk of ILD or pneumonitis.
And finally, patient education and teamwork are essential by explaining the purpose of treatment, expected adverse events, warning signs, and the importance of reporting symptoms early. APs can help patients participate actively in their care.
