The first 60 days: Advanced or recurrent endometrial cancer

What happens now

Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.

Biomarkers your report may list

MMR and MSI status (drives the size of immunotherapy benefit)p53 and POLE (molecular class)HER2 immunohistochemistry (trastuzumab deruxtecan)Oestrogen and progesterone receptors (endocrine therapy)PD-L1 (not required)TROP2 and folate receptor alpha (antibody-drug conjugate trials)CA-125 for monitoring

Ask which of these were tested and what the results were; see the report reader for what each value means.

Weeks 1 to 3

Who is on your team

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These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.

A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.

Weeks 2 to 6

Decisions coming up

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Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.

1.First line, dMMR
Carboplatin-paclitaxel with dostarlimab (RUBY) or pembrolizumab (NRG-GY018), then maintenance immunotherapy for up to three years or two years respectively.
Dostarlimab Pembrolizumab Carboplatin Paclitaxel / nab-paclitaxel RUBY / ENGOT-EN6 / GOG-3031 NRG-GY018 / KEYNOTE-868 Chemotherapy + PD-1/PD-L1 blockade, first-line advanced endometrial cancer Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)
2.First line, pMMR
Carboplatin-paclitaxel with pembrolizumab or dostarlimab, or durvalumab followed by durvalumab-olaparib maintenance (DUO-E); trastuzumab added for HER2-positive serous carcinoma.
Pembrolizumab Dostarlimab Durvalumab Olaparib DUO-E / GOG-3041 / ENGOT-EN10 Trastuzumab Microsatellite-stable (MSS) / mismatch-repair proficient (pMMR)
3.Isolated pelvic recurrence
Radiotherapy with brachytherapy for vaginal recurrence after surgery alone; exenteration in selected central recurrences after radiotherapy.
IMRT / IGRT (modern external beam)Brachytherapy Radiotherapy
4.After platinum, pMMR
Lenvatinib with pembrolizumab (KEYNOTE-775); trastuzumab deruxtecan for HER2-expressing tumours; aromatase inhibitors or progestins for low-grade receptor-positive disease.
Lenvatinib Pembrolizumab KEYNOTE-775 / Study 309 Trastuzumab deruxtecan DESTINY-PanTumor02 Letrozole (and other aromatase inhibitors)Progestins (megestrol acetate, medroxyprogesterone, levonorgestrel IUD)
5.After platinum, dMMR without prior immunotherapy
Single-agent dostarlimab or pembrolizumab.
Dostarlimab Pembrolizumab Immune checkpoint inhibitors

Every visit

Questions to ask at each visit

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Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.

Newly diagnosed

What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
Which biomarkers have been tested on my tumour (for example MMR and MSI status, p53 and POLE, HER2 immunohistochemistry, Oestrogen and progesterone receptors, PD-L1), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Primary stage III to IV endometrial cancer, First recurrence after surgery with or without adjuvant therapy, Mismatch-repair-deficient advanced disease.
Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.

First line, dMMR

For my situation (first line, dmmr), which of the standard options do you recommend and why?Guideline options include: Carboplatin-paclitaxel with dostarlimab (RUBY) or pembrolizumab (NRG-GY018), then maintenance immunotherapy for up to three years or two years respectively.
Am I a candidate for Dostarlimab, Pembrolizumab, Carboplatin or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of RUBY / ENGOT-EN6 / GOG-3031 and NRG-GY018 / KEYNOTE-868 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.

First line, pMMR

For my situation (first line, pmmr), which of the standard options do you recommend and why?Guideline options include: Carboplatin-paclitaxel with pembrolizumab or dostarlimab, or durvalumab followed by durvalumab-olaparib maintenance (DUO-E); trastuzumab added for HER2-positive serous carcinoma.
Am I a candidate for Pembrolizumab, Dostarlimab, Durvalumab or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of DUO-E / GOG-3041 / ENGOT-EN10 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.

After platinum, pMMR

For my situation (after platinum, pmmr), which of the standard options do you recommend and why?Guideline options include: Lenvatinib with pembrolizumab (KEYNOTE-775); trastuzumab deruxtecan for HER2-expressing tumours; aromatase inhibitors or progestins for low-grade receptor-positive disease.
Am I a candidate for Lenvatinib, Pembrolizumab, Trastuzumab deruxtecan or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of KEYNOTE-775 / Study 309 and DESTINY-PanTumor02 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.

After platinum, dMMR without prior immunotherapy

For my situation (after platinum, dmmr without prior immunotherapy), which of the standard options do you recommend and why?Guideline options include: Single-agent dostarlimab or pembrolizumab.
Am I a candidate for Dostarlimab, Pembrolizumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.

Isolated pelvic recurrence

For my situation (isolated pelvic recurrence), which of the standard options do you recommend and why?Guideline options include: Radiotherapy with brachytherapy for vaginal recurrence after surgery alone; exenteration in selected central recurrences after radiotherapy.

Any stage

Are there clinical trials I could join, for example of Sacituzumab tirumotecan, Rinatabart sesutecan, RAINFOL-01 (Rina-S), Trastuzumab deruxtecan?Trials are how the next standard of care is set; asking early keeps options open.
Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
I read that “What to give after progression on first-line immunotherapy”. How does that affect my plan?Open problems are where trials and second opinions matter most.
I read that “The small benefit and real toxicity of immunotherapy in proficient tumours”. How does that affect my plan?Open problems are where trials and second opinions matter most.

Weeks 3 to 8

Trials to ask about

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Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.

From day one

Help that costs nothing

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Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.

Any time

What to read next

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Words this page and the cancer page use

POLE ultramutation (POLEmut): A pathogenic mutation in the proofreading part of the POLE gene gives an endometrial tumour hundreds of mutations per megabase and, paradoxically, one of the best outlooks of any womb cancer, so finding it can spare a woman chemotherapy or radiotherapy.
Microsatellite-stable (MSS) / mismatch-repair proficient (pMMR): The 'normal' result on the mismatch-repair test: the tumour has intact DNA spell-checking and few mutations.
Radiotherapy: Using high-energy X-rays or particles to damage the DNA of cancer cells in a precisely aimed volume of the body.
Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR): Microsatellite instability is the mark of a broken DNA spell-checker (loss of MLH1, MSH2, MSH6 or PMS2) that leaves thousands of mutations, so the tumour displays abnormal proteins that T cells can recognise.

Every term links to the glossary.