DataSheet_1_Management of patients with recurrent/metastatic endometrial cancer: Consensus recommendations from an expert panel from Brazil.pdf

BackgroundEndometrial cancer is of increasing concern in several countries, including Brazil, in part because of an ageing population, declines in fertility, and the increasing prevalence of obesity. Although endometrial tumors had lagged behind other cancer types in terms of treatment improvements, molecular characterization of these tumors is paving the way for novel therapies and an expansion of the therapeutic arsenal. We aimed to help medical oncologists who manage patients with recurrent or metastatic endometrial cancer in the Brazilian healthcare setting.
MethodsThe panel, composed of 20 medical oncologists, convened in November 2021 to address 50 multiple-choice questions on molecular testing and treatment choices. We classified the level of agreement among panelists as (1) consensus (≥75% choosing the same answer), (2) majority vote (50% to <75%), or (3) less than majority vote (<50%).
ResultsConsensus was present for 25 of the 50 questions, whereas majority vote was present for an additional 23 questions. Key recommendations include molecular testing for every patient with recurrent/metastatic endometrial cancer; choice of first-line treatment according to microsatellite instability and HER2, with the addition of programmed death ligand 1 (PD-L1) and hormone receptors (HRs) for second-line therapy; carboplatin and paclitaxel as the preferred option in first-line treatment of HER2-negative disease, with the addition of trastuzumab in HER2-positive disease; pembrolizumab plus lenvatinib as a key option in second line, regardless of HER2, PD-L1 or HRs; and various recommendations regarding treatment choice for patients with distinct comorbidities.
ConclusionDespite the existing gaps in the current literature, the vast majority of issues addressed by the panel provided a level of agreement sufficient to inform clinical practice in Brazil and in other countries with similar healthcare environments.

背景：子宫内膜癌（Endometrial cancer）在包括巴西在内的多个国家愈发受到重视，其部分诱因包括人口老龄化、生育率下降以及肥胖患病率持续攀升。尽管子宫内膜肿瘤的治疗进展曾滞后于其他癌症类型，但针对这类肿瘤的分子特征分析（molecular characterization）正为新型疗法的研发与治疗手段库的扩充铺平道路。本研究旨在为巴西医疗环境中接诊复发或转移性子宫内膜癌患者的肿瘤内科医师提供临床参考。
方法：本专家组由20名肿瘤内科医师组成，于2021年11月召开会议，围绕分子检测与治疗选择相关的50道多项选择题进行研讨。我们将专家组的共识等级划分为三类：(1) 完全共识（≥75%的专家选择同一答案）；(2) 多数意见（50%~<75%的专家选择同一答案）；(3) 未达多数共识（<50%的专家选择同一答案）。
结果：50道题目中共有25道达成完全共识，另有23道形成多数意见。核心推荐内容包括：对所有复发/转移性子宫内膜癌患者实施分子检测；一线治疗方案需依据微卫星不稳定性（microsatellite instability）与HER2状态进行选择，二线治疗则需额外检测程序性死亡配体1（PD-L1）与激素受体（HRs）；对于HER2阴性患者，首选一线治疗方案为卡铂（carboplatin）联合紫杉醇（paclitaxel），HER2阳性患者需加用曲妥珠单抗（trastuzumab）；无论HER2、PD-L1或HRs状态如何，帕博利珠单抗（pembrolizumab）联合仑伐替尼（lenvatinib）均为二线治疗的核心可选方案；此外还针对合并不同基础疾病的患者给出了多项治疗选择相关的临床推荐。
结论：尽管当前相关文献仍存在诸多空白，但专家组所研讨的绝大多数议题均达成了足够的共识水平，可为巴西及其他医疗环境相似的国家的临床实践提供指导依据。