ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma

Concin, Nicole; Matías‐Guiu, Xavier; Vergote, Ignace; Cibula, David; Mirza, Mansoor Raza; Marnitz, Simone; Ledermann, Jonathan A.; Bosse, Tjalling; Chargari, Cyrus; Fagotti, Anna; Fotopoulou, Christina; Martín, Antonio González; Lax, Sigurd; Lorusso, Domenica; Marth, Christian; Morice, Philippe; Nout, Remi A.; O’Donnell, D.; Querleu, Denis; Raspollini, Maria Rosaria; Sehouli, Jalid; Sturdza, Alina; Taylor, Alexandra; Westermann, Anneke M.; Wimberger, Pauline; Colombo, Nicoletta; Planchamp, François; Creutzberg, Carien L.

doi:10.1016/j.radonc.2020.11.018

Cited by 165 publications

(240 citation statements)

References 413 publications

(282 reference statements)

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“…This molecular classification was very recently incorporated into the ESGO recommendations [11]. However, this molecular classification alone does not explain the different responses to systemic therapies.…”

Section: Introductionmentioning

confidence: 99%

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Endometrial Carcinoma: Immune Microenvironment and Emerging Treatments in Immuno-Oncology

et al. 2021

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Endometrial cancer (EC) can easily be cured when diagnosed at an early stage. However, advanced and metastatic EC is a common disease, affecting more than 15,000 patients per year in the United Sates. Only limited treatment options were available until recently, with a taxane–platinum combination as the gold standard in first-line setting and no efficient second-line chemotherapy or hormone therapy. EC can be split into four molecular subtypes, including hypermutated cases with POLE mutations and 25–30% harboring a microsatellite instability (MSI) phenotype with mismatch repair deficiency (dMMR). These tumors display a high load of frameshift mutations, leading to increased expression of neoantigens that can be targeted by the immune system, including (but not limited) to T-cell response. Recent data have demonstrated this impact of programmed death 1 and programmed death ligand 1 (PD-1/PD-L1) inhibitors on chemo-resistant metastatic EC. The uncontrolled KEYNOTE-158 and GARNET trials have shown high response rates with pembrolizumab and dostarlimab in chemoresistant MSI-high tumors. Most responders experiment long responses that last more than one year. Similar, encouraging results were obtained for MMR proficient (MMRp) cases treated with a combination of pembrolizumab and the angiogenesis inhibitor lenvatinib. Approvals have, thus, been obtained or are underway for EC with immune checkpoint inhibitors (ICI) used as monotherapy, and in combination with antiangiogenic agents. Combinations with other targeted therapies are under evaluation and randomized studies are ongoing to explore the impact of ICI-chemotherapy triplets in first-line setting. We summarize in this review the current knowledge of the immune environment of EC, both for MMRd and MMRp tumors. We also detail the main clinical data regarding PD-1/PD-L1 inhibitors and discuss the next steps of development for immunotherapy, including various ICI-based combinations planned to limit resistance to immunotherapy.

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Section: Introductionmentioning

confidence: 99%

“…However, this molecular classification alone does not explain the different responses to systemic therapies. A better description of the tumor immune micro-environment could refine the prognosis and help define new targets for immunooncological therapies [11].…”

Section: Introductionmentioning

confidence: 99%

Endometrial Carcinoma: Immune Microenvironment and Emerging Treatments in Immuno-Oncology

et al. 2021

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“…European Society of Gynaecological Oncology (ESGO)-European Society for Radiotherapy & Oncology (ESTRO)-European Society of Pathology (ESP) 2021 guidelines recommend SLNB can be considered for staging purposes in patients with low risk/intermediate risk EC, although it can be omitted in cases without myometrial invasion. Systematic lymphadenectomy is not recommended in this group [ 3 ].…”

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confidence: 99%

“…There is scientific evidence suggesting extensive LVI is associated with adverse prognostic factors and worse outcomes when compared to EC with focal or no LVI. Extensive LVI is an indicator for the need of adjuvant treatment, as recommended in the 2016 ESGO-ESTRO-ESMO [ 7 ] and the most recent 2021 ESGO-ESTRO-ESP guidelines [ 3 ].…”

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Relevance of pathologic features in risk stratification for early-stage endometrial cancer

Guerra

Matías‐Guiu

2021

J Gynecol Oncol

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FIGO staging of endometrial cancer: 2023

Berek

Matías‐Guiu

Creutzberg

et al. 2023

Intl J Gynecology & Obste

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Introduction: Many advances in the understanding of the pathologic and molecular features of endometrial cancer have occurred since the FIGO staging was last updated in 2009. Substantially more outcome and biological behavior data are now available regarding the several histological types. Molecular and genetic findings have accelerated since the publication of The Cancer Genome Atlas (TCGA) data and provide improved clarity on the diverse biological nature of this collection of endometrial cancers and their differing prognostic outcomes. The goals of the new staging system are to better define these prognostic groups and create substages that indicate more appropriate surgical, radiation, and systemic therapies. Methods: The FIGO Women's Cancer Committee appointed a Subcommittee on Endometrial Cancer Staging in October 2021, represented by the authors. Since then, the committee members have met frequently and reviewed new and established evidence on the treatment, prognosis, and survival of endometrial cancer. Based on these data, opportunities for improvements in the categorization and stratification of these factors were identified in each of the four stages. Data and analyses from the molecular and histological classifications performed and published in the recently developed ESGO/ESTRO/ESP guidelines were used as a template for adding the new subclassifications to the proposed molecular and histological staging system. Results: Based on the existing evidence, the substages were defined as follows: Stage I (IA1): non-aggressive histological type of endometrial carcinoma limited to a polyp or confined to the endometrium; (IA2) non-aggressive histological types of endometrium involving less than 50% of the myometrium with no or focal lymphovascular space invasion (LVSI) as defined by WHO criteria; (IA3) low-grade endometrioid carcinomas limited to the uterus with simultaneous low-grade endometrioid ovarian involvement; (IB) non-aggressive histological types involving 50% or more of the myometrium with no LVSI or focal LVSI; (IC) aggressive histological types, i.e. serous,

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ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma

Cited by 165 publications

References 413 publications

Endometrial Carcinoma: Immune Microenvironment and Emerging Treatments in Immuno-Oncology

Endometrial Carcinoma: Immune Microenvironment and Emerging Treatments in Immuno-Oncology

Relevance of pathologic features in risk stratification for early-stage endometrial cancer

FIGO staging of endometrial cancer: 2023

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