Endometrial Carcinoma Treatment Regimens

Endometrial Carcinoma Treatment Regimens

Clinical Trials: The NCCN recommends cancer patient participation in clinical trials as the gold standard for treatment.

Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced health care team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These regimens are provided only to supplement the latest treatment strategies.


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These Guidelines are a work in progress that may be refined as often as new significant data become available. The NCCN Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The NCCN makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way.

Note: All recommendations are category 2A unless otherwise indicated.

▶Systemic Therapy for Endometrial Carcinoma1

REGIMEN

DOSING

Primary or Adjuvant Treatment When Used for Uterine-Confined High-Risk Disease

Preferred Regimens

Carboplatin/Paclitaxel2-6,b

Premedication is required for Paclitaxel

Day 1: Paclitaxel 175mg/m2 IV over 3 hours, followed by:

Day 1: Carboplatin AUC 6-7.5 IV over 30 minutes.

Repeat cycle every 3 weeks for 6 cycles.

Recurrent or Metastatic Diseasec

Systemic Therapies

Preferred Regimens

Carboplatin/Paclitaxel
(Category 1 for carcinosarcoma)2-6,b
Premedication is required for Paclitaxel

Day 1: Paclitaxel 175mg/m2 IV over 3 hours, followed by:

Day 1: Carboplatin AUC 6 IV over 30 minutes.

Repeat cycle every 3 weeks for a maximum of 7 cycles.

Carboplatin/Paclitaxel/ Trastuzumab
(Stage III/IV recurrent HER2- positive uterine serious carcinoma)2,3,7,8,b,d
Premedication is required for Paclitaxel

Day 1: Paclitaxel 175mg/m2 IV over 3 hours, followed by:

Day 1: Carboplatin AUC 5 IV over 30 minutes

Day 1 (Cycle 1): Trastuzumab 8mg/kg IV over 90 minutes, followed by:

Day 2 (Beginning with Cycle 2): Trastuzumab 6mg/kg IV over 30 minutes.

Repeat cycle every 3 weeks for a maximum of 6 cycles.

Followed by:

Day 1 (Beginning with Cycle 7): Trastuzumab 6mg/kg IV over 30 minutes.

Repeat cycle every 3 weeks.

Other Recommended Regimens

Albumin-Bound Paclitaxel9-11,e

Day 1: Albumin-bound paclitaxel 260mg/m2 IV over 30 minutes.

Repeat cycle every 3 weeks.

OR

Day 1,8,15: Albumin-bound paclitaxel 100-125mg/m2 IV over 30 minutes.

Repeat cycle every 4 weeks.

Bevacizumab12,13,d,f

Day 1: Bevacizumab 15mg/kg IV.

Repeat cycle every 3 weeks.

Carboplatin3,14

Day 1: Carboplatin AUC 5-7 IV over 30 minutes.

Repeat cycle every 3 weeks.

Carboplatin/Docetaxel3,15-17,f,g,h,i
Premedication is required for Docetaxel

Day 1: Docetaxel 60mg/m2 IV over 1 hour, followed by:

Day 1: Carboplatin AUC 6 IV over 30 minutes.

Repeat cycle every 3 weeks.

Carboplatin/Paclitaxel/
Bevacizumab3,12,18,19,b,d,f
Premedication is required for Paclitaxel

Day 1: Paclitaxel 175mg/m2 IV over 3 hours, followed by:

Day 1: Carboplatin AUC 5 IV over 30 minutes

Day 1: Bevacizumab 15mg/kg IV.

Repeat cycle for 3 weeks every 6-8 cycles, followed by:

Day 1: Bevacizumab 15mg/kg IV.

Repeat cycle every 3 weeks (maintenance therapy).

Cisplatin20,21,j

Day 1: Cisplatin 50mg/m2 IV over 1 hour.

Repeat cycle every 3 weeks.

Cisplatin/Doxorubicin20,22-24,j,k

Day 1: Doxorubicin 60mg/m2 IV push

Day 1: Cisplatin 50mg/m2 over 1 hour.

Repeat cycle every 3 weeks until reaching a lifetime cumulative anthracycline dose.

OR

Day 1: Doxorubicin 45mg/m2 (if pelvic floor radiation) IV push

Day 1: Cisplatin 50mg/m2 over 1 hour.

Repeat cycle every 3 weeks until reaching a lifetime cumulative anthracycline dose.

Cisplatin/Doxorubicin/
Paclitaxel2,20,22,24,b,j,k,l
Premedication is required for Paclitaxel

Day 1: Doxorubicin 45mg/m2 IV push

Day 1: Cisplatin 50mg/m2 over 1 hour

Day 2: Paclitaxel 160mg/m2 IV over 3 hours.

Repeat cycle every 3 weeks until reaching a lifetime cumulative anthracycline dose.

Cisplatin/Ifosfamide
(Carcinosarcoma)20,25-27,j,m

Days 1-4: Ifosfamide 1,500mg/m2 IV over 3 hours daily

Days 1-4: Mesna 300mg/m2 IV over 15 minutes three times daily (one dose before ifosfamide, then at 4 and 8 hours from the start of each ifosfamide dose)

Days 1-4: Cisplatin 20mg/m2 IV over 1 hour.

Repeat cycle every 3 weeks.

OR

Days 1-4: Ifosfamide 1,200mg/m2 (if prior pelvic radiation) IV over 3 hours daily

Days 1-4: Mesna 240mg/m2 IV over 15 minutes three times daily (one dose before ifosfamide, then at 4 and 8 hours from the start of each ifosfamide dose)

Days 1-4: Cisplatin 20mg/m2 IV over 1 hour.

Repeat cycle every 3 weeks.

Docetaxel (Category 2B)15,28,g,h
Premedication is required for Paclitaxel

Day 1: Docetaxel 70mg/m2 IV over 1 hour.

Repeat cycle every 3 weeks.

Doxorubicin22,29-31,k

Day 1: Doxorubicin 60mg/m2 IV push.

Repeat cycle every 3 weeks until reaching a lifetime cumulative anthracycline dose.

Ifosfamide (Carcinosarcoma)25,32,m

Days 1-3: Ifosfamide 2,000mg/m2 IV over 3 hours daily

Days 1-3: Mesna 400mg/m2 IV over 15 minutes three times daily (one dose before ifosfamide, then at 4 and 8 hours from the start of each ifosfamide dose).

Repeat cycle every 3 weeks.

OR

Days 1-3: Ifosfamide 1,200mg/m2 (if prior pelvic radiation) IV over 3 hours daily

Days 1-3: Mesna 240mg/m2 IV over 15 minutes three times daily (one dose before ifosfamide, then at 4 and 8 hours from the start of each ifosfamide dose).

Repeat cycle every 3 weeks.

Ifosfamide/Paclitaxel
(Carcinosarcoma)2,25,32,b,i,m
Premedication is required for Paclitaxel

Days 1-3: Ifosfamide 1,600mg/m2 IV over 3 hours daily

Days 1-3: Mesna 320mg/m2 IV over 15 minutes three times daily (one dose before ifosfamide, then at 4 and 8 hours from the start of each ifosfamide dose)

Day 1: Paclitaxel 135mg/m2 IV over 3 hours.

Repeat cycle every 3 weeks.

OR

Days 1-4: Ifosfamide 1,200mg/m2 (if prior pelvic radiation) IV over 3 hours daily

Days 1-4: Mesna 240mg/m2 IV over 15 minutes three times daily (one dose before ifosfamide, then at 4 and 8 hours from the start of each ifosfamide dose)

Day 1: Paclitaxel 135mg/m2 IV over 3 hours.

Repeat cycle every 3 weeks.

Liposomal Doxorubicin33-35,k

Day 1: Liposomal doxorubicin 40-50mg/m2 IV push.

Repeat cycle every 4 weeks until reaching a lifetime cumulative anthracycline dose.

Paclitaxel2,31,36,b
Premedication is required for Paclitaxel

Day 1: Paclitaxel 175mg/m2 IV over 3 hours.

Repeat cycle every 3 weeks.

Temsirolimus37,38,o
Premedication is required for Temsirolimus

Days 1,8,15,22: Temsirolimus 25mg IV over 30 minutes.

Repeat cycle every 4 weeks.

Topotecan39,40

Days 1-5: Topotecan 1mg/m2 IV over 30 minutes daily.

Repeat cycle every 3 weeks.

OR

Days 1-5: Topotecan 0.8mg/m2 (if prior pelvic radiation) IV over 30 minutes daily.

Repeat cycle every 3 weeks.

Biomarker-Directed Systemic Therapy for Second-Line Treatment

Preferred Regimens

Lenvatinib/Pembrolizumab
(Category 1)
(Non-MSI-H/non-dMMR tumors)41-43,a,n

Days 1-21: Lenvatinib 20mg orally daily.

Day 1: Pembrolizumab 200mg IV.

Repeat cycle every 3 weeks.

Pembrolizumab
(TMB-H or non-MSI-H/non-dMMR tumors)41,44,45,a,n

Days 1: Pembrolizumab 200mg IV over 30 minutes.

Repeat cycle every 3 weeks until up to 24 months of therapy has been completed.

OR

Day 1: Pembrolizumab 400mg IV over 30 minutes.

Repeat cycle every 6 weeks until up to 24 months of therapy has been completed.

Other Recommended Regimens

Avelumab
(MSI-H/dMMR tumors)46,a,n

See NCCN Uterine Neoplasms Guidelines1

Cabozantinib47

See NCCN Uterine Neoplasms Guidelines1

Dostarlimab-gxly
(MSI-H/dMMR tumors)48,49,a,n

Day 1 (Cycles 1-4): Dostarlimab-gxly 500 mg IV.

Repeat every 3 weeks, followed by:

Day 1 (Beginning with Cycle 5): Dostarlimab-gxly 1000mg IV.

Repeat cycle every 6 weeks.

Entrectinib
(Category 2B)
(NTRK gene fusion-positive tumors)50

See NCCN Uterine Neoplasms Guidelines1

Larotrectinib
(Category 2B)
(NTRK gene fusion-positive tumors)51

See NCCN Uterine Neoplasms Guidelines1

Nivolumab
(MSI-H/dMMR tumors)52,53,a,n

See NCCN Uterine Neoplasms Guidelines1

Hormone Therapyp

Preferred Regimens

Anastrazole54

See NCCN Uterine Neoplasms Guidelines1

Exemestane55

See NCCN Uterine Neoplasms Guidelines1

Fulvestrant56

See NCCN Uterine Neoplasms Guidelines1

Letrozole57

See NCCN Uterine Neoplasms Guidelines1

Levonorgesterol IUD
(Select fertility-sparing cases)

See NCCN Uterine Neoplasms Guidelines1

Megestrol Acetate

See NCCN Uterine Neoplasms Guidelines1

Megestrol Acetate/
Tamoxifen (Alternating)

See NCCN Uterine Neoplasms Guidelines1

Medroxyprogesterone Acetate

See NCCN Uterine Neoplasms Guidelines1

Medroxyprogesterone Acetate/
Tamoxifen (Alternating)

See NCCN Uterine Neoplasms Guidelines1

Tamoxifen58

See NCCN Uterine Neoplasms Guidelines1

Other Recommended Regimens

Everolimus/Letrozole
(Endometroid histology)57,59,60

Days 1-28: Everolimus 10mg orally daily

Days 1-28: Letrozole 2.5 mg orally daily.

Repeat cycle every 4 weeks.

  a CSFs = colony-stimulating factors; dMMR = deficient mismatch repair; IUD = intrauterine device; MSI-H = high levels of microsatellite instability; TMB-H = tumor mutational burden-high

  b For Paclitaxel: Premedication for hypersensitivity is required. The recommended dosing is:

    ⦁ H2 antagonist

      — Famotidine 20mg IV or orally (or equivalent H2 blocker) 30-60 minutes pre-Paclitaxel AND

    ⦁ H1 antagonist

      — Diphenhydramine 12.5-50mg IV or orally 30-60 minutes pre-Paclitaxel AND

    ⦁ Dexamethasone (for 21-day regimen):

      — Dexamethasone 20mg orally approximately 12 and 6 hours pre-Paclitaxel OR

      — Dexamethasone 20mg IV 30 minutes pre-Paclitaxel

    ⦁ Dexamethasone (for weekly regimens):

      — Dexamethasone 10mg IV 30 minutes pre-Paclitaxel

  c Chemotherapy regimens can be used for all carcinoma histologies. Carcinosarcomas are now considered and treated as high-grade carcinomas.

  d An FDA-approved biosimilar is an appropriate substitute for Trastuzumab and Bevacizumab.

  e Albumin-bound Paclitaxel is a reasonable substitute for patients with a hypersensitivity to Paclitaxel if the skin testing to Paclitaxel is negative. If the patient has a positive skin test to Paclitaxel then the patient requires desensitization to paclitaxel. Albumin-bound Paclitaxel is not a reasonable substitute for the patient skin test is positive.

  f Bevacizumab may be considered for use in patients who have progressed on prior cytotoxic chemotherapy.

  g For Docetaxel: Premedication with Dexamethasone for fluid retention is required. One recommended dosing strategy is: Dexamethasone 8mg orally the night before, the morning of, and the night of Docetaxel administration.

  h Docetaxel may be considered for patients in whom Paclitaxel is contraindicated.

  i CSFs may be considered for primary prophylaxis based on the febrile neutropenia risk of the chemotherapy regimen.

  j Hydration is required with supplemental electrolytes pre- and post-administration of Cisplatin.

  k Doxorubicin is an anthracycline. Cumulative anthracycline dosage should be monitored.

  l The Cisplatin/Doxorubicin/Paclitaxel regimen is not widely used because of concerns related to toxicity.

  m Hydration is required pre- and post-administration of Ifosfamide.

  n Early- and late-onset immune-related adverse events affecting multiple organ systems can occur in patients receiving immune checkpoint inhibitors. Patients with neurologic or life-threatening autoimmune disorders as well as receiving high levels of immunosuppression for their underlying disease should be approached with caution when considering immunotherapy. All patients will require extensive resources including ongoing intensive monitoring and supportive care.

  o For Temsirolimus: premedication for hypersensitivity and/or infusion reactions is required. The recommended dosing is diphenhydramine 12.5-50mg IV or orally 30 minutes pre-Temsirolimus.

  p Hormonal therapy is typically used for lower-grade endometroid histologies, preferable in patients with small tumor volume or an indolent growth pace.

References

1. Referenced with permission from NCCN Clinical Practice Guidelines in Oncology™, Uterine Neoplasms. V1.2022. https://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf. Accessed October 3, 2022.

2. Paclitaxel [package insert]. Piscataway, NJ: Novadoz Pharmaceuticals LLC; ­August 2020. Paclitaxel Injection (Patient Information Included) Rx only (nih.gov). Accessed October 4, 2022.

3. Carboplatin [package insert]. Lake Forest, IL: Hospira Inc.; April 2018. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=40c0abf0-06ad-8658-a784-6554a540a768&type=display. Accessed October 4, 2022.

4. Miller D, Filiaci V, Fleming G, et al. Randomized phase III noninferiority trial of first line chemotherapy for metastatic or recurrent endometrial carcinoma: A Gynecologic Oncology Group study [Abstract LBA1]. Gynecol Oncol. 2012;125(3):771.

5. Secord AA, Havrilesky LJ, O’Malley DM, et al. A multicenter evaluation of sequential multimodality therapy and clinical outcome for the treatment of advanced endometrial cancer. Gynecol Oncol. 2009;114:442-447. doi: 10.1016/j.ygyno.2009.06.005.

6. Fields AL, Einstein MH, Novetsky AP, et al. Pilot phase II Trial of radiation “sandwiched” between combination paclitaxel/platinum chemotherapy in patients with uterine papillary serous carcinoma (UPSC). Gynecol Oncol. 2008;108:201-206. doi: 10.1016/j.ygyno.2007.09.025

7. Trastuzumab (Herceptin) [package insert]. South San Francisco, CA: Genentech Inc; February 2021. https://www.gene.com/download/pdf/herceptin_prescribing.pdf. Accessed October 4, 2022.

8. Fader AN, Roque DM, Siegel E, et al. Randomized Phase II Trial of Carboplatin-Paclitaxel Versus Carboplatin-Paclitaxel-Trastuzumab in Uterine Serous Carcinomas That Overexpress Human Epidermal Growth Factor Receptor 2/neu. J Clin Oncol. 2018;36(20):2044-2051. doi: 10.1200/JCO.2017.76.5966

9. Paclitaxel protein bound (Abraxane) [package insert]. Summit, NJ: Celgene Corporation; August 2020. https://packageinserts.bms.com/pi/pi_abraxane.pdf. Accessed October 30, 2022.

10. Gradishar WJ, Tjulandin S, Davidson N, et al. Phase III trial of nanoparticle ­albumin-bound paclitaxel compared with polyethylated castor oil-based paclitaxel in women with breast cancer. J Clin Oncol. 2005;23(31):7794-7803. doi: 10.1200/JCO.2005.04.937

11. Alberts DS, Blessing JA, Landrum LM, et al. Phase II trial of nab-paclitaxel in the treatment of recurrent or persistent advanced cervix cancer: A gynecologic oncology group study. Gynecol Oncol. 2012;127(3):451-455. doi: 10.1016/j.ygyno.2012.09.008

12. Bevacizumab (Avastin) [package insert]. South San Francisco, CA: Genentech, Inc.; September 2022. avastin_prescribing.pdf (gene.com). Accessed October 4, 2022.

13. Aghajanian C, Sill MW, Darcy KM, et al. Phase II trial of bevacizumab in recurrent or persistent endometrial cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2011;29(16):2259-2265. doi: 10.1200/JCO.2010.32.6397

14. Hoskins PJ, Swenerton KD, Pike JA, et al. Paclitaxel and carboplatin, alone or with irradiation, in advanced or recurrent endometrial cancer: a phase II study. J Clin Oncol. 2001;19(20):4048-4053. doi: 10.1200/JCO.2001.19.20.4048

15. Docetaxel injection [package insert]. Lake Forest, IL; Hospira, Inc. December 2021. These highlights do not include all the information needed to use DOCETAXEL INJECTION safely and effectively. See full prescribing information for DOCETAXEL INJECTION. DOCETAXEL injection, for intravenous use Initial U.S. Approval: 1996 (nih.gov). Accessed October 4, 2022.

16. Geller MA, Ivy JJ, Ghebre R, et al. A phase II trial of carboplatin and docetaxel followed by radiotherapy given in a “sandwich” method for stage III, IV, and recurrent endometrial cancer. Gynecol Oncol. 2011;121(1):112-117. doi: 10.1016/j.ygyno.2010.12.338

17. Glasgow M, Vogel RI, Burgart J, et al. Long term follow-up of a phase II trial of multimodal therapy given in a “sandwich” method for stage III, IV, and recurrent endometrial cancer. Gynecol Oncol Res Pract. 2016;3:6. doi: 10.1186/s40661-016-0027-4

18. Rose PG, Ali S, Moslemi-Kebria M, Simpkins F. Paclitaxel, carboplatin, and bevacizumab in advanced and recurrent endometrial carcinoma. Int J Gynecol Cancer. 2017;27(3):452-458. doi: 10.1097/IGC.0000000000000891

19. Simpkins F, Drake R, Escobar PF, Nutter B, Rasool N, Rose PG. A phase II trial of paclitaxel, carboplatin, and bevacizumab in advanced and recurrent endometrial carcinoma (EMCA). Gynecol Oncol. 2015;136(2):240-245. doi: 10.1016/j.ygyno.2014.12.004

20. Cisplatin solution for injection [package insert]. Paramus, NJ: WG Critical Care LLC; September 2021. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=508496cb-3441-46b3-a4fe-e0d440e6adc6&type=display. Accessed October 4, 2022.

21. Thigpen JT, Blessing JA, Homesley H, et al. Phase II trial of cisplatin as first-line chemotherapy in patients with advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group Study. Gynecol Oncol. 1989;33(1):68-70. doi: 10.1016/0090-8258(89)90605-7

22. Doxorubicin (Adriamycin) [package insert]. Eatontown, NJ: Hikma Pharmaceuticals USA Inc; March 2021. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=62aa88d-1e25-4049-87ec-99d42edd1d31&type=display. Accessed October 4, 2022.

23. Fleming GF, Brunetto VL, Cella D, et al. Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2004;22(11):2159-2166. doi: 10.1200/JCO.2004.07.184

24. Homesley HD, Filiaci V, Gibbons SK, et al. A randomized phase III trial in advanced endometrial carcinoma of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: A Gynecologic Oncology Group study. Gynecol Oncol. 2009;112(3):543-552. doi: 10.1016/j.ygyno.2008.11.014

25. Ifosfamide (Ifex) [package insert]. Deerfield, IL: Baxter Healthcare Corporation; July 2018. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=91e433a9-6800-43a6-ac13-a49a04a5aecd&type=display. Accessed October 4, 2022.

26. Mesna (Mesnex) [package insert]. Deerfield, IL: Baxter Healthcare Corporation; December 2018. These highlights do not include all the information needed to use mesna safely and effectively. See full prescribing information for mesna. MESNEX (mesna) tablets, for oral use Mesna injection, for intravenous use Initial U.S. Approval: 1988 (nih.gov). Accessed October 4, 2022.

27. Sutton G, Kauderer J, Carson LF, et al. Adjuvant ifosfamide and cisplatin in patients with completely resected stage I or II carcinosarcomas (mixed mesodermal tumors) of the uterus: a Gynecologic Oncology Group study. Gynecol Oncol. 2005;96(3):630-634. doi: 10.1016/j.ygyno.2004.11.022

28. Katsumata N, Noda K, Nozawa S, et al. Phase II trial of docetaxel in advanced or metastatic endometrial cancer: a Japanese Cooperative Study. Br J Cancer. 2005;93(9):999-1004. doi: 10.1038/sj.bjc.6602817

29. Thigpen JT, Buchsbaum HJ, Mangan C, Blessing JA. Phase II trial of adriamycin in the treatment of advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group study. Cancer Treat Rep. 1979;63(1):21-27.

30. Thigpen JT, Blessing JA, DiSaia PJ, et al. A randomized comparison of doxorubicin alone versus doxorubicin plus cyclophosphamide in the management of advanced or recurrent endometrial carcinoma: A Gynecologic Oncology Group study. J Clin Oncol. 1994;12(7):1408-1414. doi: 10.1200/JCO.1994.12.7.1408

31. McMeekin S, Dizon D, Barter J, et al. Phase III randomized trial of second-line ­ixabepilone versus paclitaxel or doxorubicin in women with advanced endometrial cancer. Gynecol Oncol. 2015;138(1):18-23. doi: 10.1016/j.ygyno.2015.04.026

32. Homesley HD, Filiaci V, Markman M, et al. Phase III trial of ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2007;25(5):526-531. doi: 10.1200/JCO.2006.06.4907

33. Doxorubicin [liposomal] (Doxil) [package insert]. Deerfield, IL: Baxter Healthcare Corporation; May 2022. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=1c153e9e-4cf2-4ac7-9cf9-16f9b48d7dce&type=display. Accessed October 4, 2022.

34. Homesley HD, Blessing JA, Sorosky J, et al. Phase II trial of liposomal doxorubicin at 40 mg/m(2) every 4 weeks in endometrial carcinoma: a Gynecologic Oncology Group Study. Gynecol Oncol. 2005;98(2):294-298. doi: 10.1016/j.ygyno.2005.05.016

35. Muggia FM, Blessing JA, Sorosky J, Reid GC. Phase II trial of the pegylated liposomal doxorubicin in previously treated metastatic endometrial cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2002;20(9):2360-2364. doi: 10.1200/JCO.2002.08.171

36. Dimopoulos MA, Papadimitriou CA, Georgoulias V, et al. Paclitaxel and cisplatin in advanced or recurrent carcinoma of the endometrium: long-term results of a phase II multicenter study. Gynecol Oncol. 2000;78(1):52-57. doi: 10.1006/gyno.2000.5827

37. Temsirolimus (Torisel) [package insert]. Philadelphia, PA: Pfizer Inc; March 2018. https://labeling.pfizer.com/showlabeling.aspx?id=490. Accessed October 4, 2022.

38. Oza AM, Elit L, Tsao MS, et al. Phase II study of temsirolimus in women with recurrent or metastatic endometrial cancer: a trial of the NCIC Clinical Trials Group. J Clin Oncol. 2011;29(24):3278-3285. doi: 10.1200/JCO.2010.34.1578

39. Topotecan injection (Hycamtin) [package insert]. East Hanover, NJ: Novartis ­Pharmaceuticals Corporation; September 2018. These highlights do not include all the information needed to use HYCAMTIN CAPSULES safely and effectively. See full prescribing information for HYCAMTIN CAPSULES. HYCAMTIN® (topotecan) capsules, for oral useInitial U.S. Approval: 1996 (nih.gov). Accessed October 4, 2022.

40. Wadler S, Levy DE, Lincoln ST, et al. Topotecan is an active agent in the first-line treatment of metastatic or recurrent endometrial carcinoma: Eastern Cooperative Oncology Group Study E3E93. J Clin Oncol. 2003;21(11):2110-2114. doi: 10.1200/JCO.2003.12.093

41. Pembrolizumab (Keytruda) [package insert]. Whitehouse Station, NJ: Merck & Co Inc; August 2022. keytruda_pi.pdf (merck.com). Accessed October 4, 2022.

42. Lenvatinib (Lenvima) [package insert]. Nutley, NJ: Eisai Inc; August 2022. prescribing-information.pdf (lenvima.com). Accessed October 4, 2022.

43. Makker V, Rasco D, Vogelzang NJ, et al. Lenvatinib plus pembrolizumab in patients with advanced endometrial cancer: an interim analysis of a multicenter, open-label, ­single-arm, phase 2 trial. Lancet Oncol. 2019;20:711-718. doi: 10.1016/S1470-2045(19)30020-8

44. Lala M, Li TR, de Alwis DP, et al. A six-weekly dosing schedule for pembrolizumab in patients with cancer based on evaluation using modelling and simulation [published correction appears in Eur J Cancer. 2021 Feb;144:400]. Eur J Cancer. 2020;131:68-75. doi: 10.1016/j.ejca.2020.02.016

45. Marabelle A, Le DT, Ascierto PA, et al. Efficacy of pembrolizumab in patients with noncolorectal high microsatellite instability/mismatch repair-deficient cancer: results from the phase II KEYNOTE-158 study. J Clin Oncol. 2020;38(1):1-10. doi: 10.1200/JCO.19.02105

46. Avelumab (Bavencio) [package insert]. July 2022. Rockville, MD: EMD Serono, Inc. July 2022. BAVENCIO® Full Prescribing Information (emdserono.com). Accessed October 4, 2022.

47. Cabozantinib (Cabometyx) [package insert]. Alameda, CA: Exelixis, Inc; July 2022. https://www.cabometyxhcp.com/sites/default/files/2021-03/prescribing-­information.pdf. Accessed October 4, 2022.

48. Dostarlimab-gxly (Jemperli) [package insert]. Research Triangle Park, NC: GlaxoSmithKline; April 2022. https://gskpro.com/content/dam/global/hcpportal/en_US/Prescribing_Information/Jemperli/pdf/JEMPERLI-PI-MG.PDF. Accessed October 4, 2022.

49. Oaknin A, Tinker AV, Gilbert L, et al. Clinical activity and safety of the anti-programmed death 1 monoclonal antibody dostarlimab for patients with recurrent or advanced mismatch repair-deficient endometrial cancer: a nonrandomized phase 1 clinical trial. JAMA Oncol. 2020;5:1766-1772. doi: 10.1001/jamaoncol.2020.4515

50. Entrectinib (Rozlytrek) [package insert]. South San Francisco, CA: Genentech, Inc.; July 2022. rozlytrek_prescribing.pdf (gene.com). Accessed October 4, 2022.

51. Larotrectinib (Vitrakvi) [package insert]. Whippany, NJ: Bayer Healthcare Pharmaceuticals Inc.; March 2021. https://labeling.bayerhealthcare.com/html/products/pi/vitrakvi_PI.pdf. Accessed October 5, 2022.

52. Nivolumab (Opdivo) [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; July 2022. pi_opdivo.pdf (bms.com). Accessed October 5, 2022.

53. Azad NS, Gray RJ, Overman MJ, et al. Nivolumab is effective in mismatch repair-deficient nonocolorectal cancers: Results from Arm ZID-A subprotocol of the NCI-Match (EAY 131) study. J Clin Oncol. 2020;38:214-222. doi: 10.1200/JCO.19.00818

54. Anastrozole (Arimidex) [package insert]. Baudette, MN: ANI Pharmaceuticals, Inc.; August 2019. These highlights do not include all the information needed to use ARIMIDEX safely and effectively. See full prescribing information for ARIMIDEX. ARIMIDEX® (anastrozole) tablet, for oral use Initial U.S. Approval: 1995 (nih.gov). Accessed October 5, 2022.

55. Exemestane (Aromasin) [package insert]. New York, NY: Pfizer, Inc.; January 2010. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=f0b31daa-0792-43d5-af08-8b6a864dc90a&type=display. Accessed October 4, 2022.

56. Fulvestrant (Faslodex) [package insert]. Wilmington, DE: AstraZeneca ­Pharmaceuticals LP: September 2020. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=83d7a440-e904-4e36-afb5-cb02b1c919f7&type=display. Accessed October 5, 2022.

57. Letrozole (Femara) [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; May 2020. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=82b77d74-085f-45ac-a7dd-1f5c038bf406&type=display. Accessed October 5, 2022.

58. Tamoxifen (Novladex) [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; August 2004. 17970s053lbl.pdf (fda.gov). Accessed October 5, 2022.

59. Everolimus (Afinitor) [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; February 2022. https://www.novartis.com/us-en/sites/novartis_us/files/afinitor.pdf. Accessed October 4, 2022.

60. Slomovitz BM, Jiang Y, Yates MS, et al. Phase II study of everolimus and letrozole in patients with recurrent endometrial carcinoma. J Clin Oncol. 2015;33(8):930-936. doi: 10.1200/JCO.2014.58.3401

(Revised 10/2022; v1.2022 Uterine Neoplasms Guidelines) ©2022 Haymarket Media, Inc.

This article originally appeared on Cancer Therapy Advisor