Mismatch-repair-deficient endometrial cancer: lines of therapy

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5 standard-of-care settings across 4 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

Line	All comers
Screening, prevention and diagnosis	1
Early / localised	1
Second line	2
Other settings	1

Screening, prevention and diagnosis

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Diagnosis and hereditary risk	Universal MMR immunohistochemistry on every endometrial cancer; MLH1 methylation testing on MLH1-deficient tumours; germline testing and cascade testing of relatives when methylation is absent.	Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)Lynch syndromeGermline (hereditary) testingHistopathology & immunohistochemistryEndometrial cancer molecular classes (POLEmut, MMRd, p53abn, NSMP)		95

Early / localised

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Early stage after surgery	Adjuvant therapy by stage and risk factors as for no specific molecular profile: vaginal brachytherapy for intermediate risk, pelvic radiotherapy for high-intermediate risk; chemotherapy adds little (PORTEC-3).	BrachytherapyIMRT / IGRT (modern external beam)PORTEC-3		93

Second line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Advanced or recurrent, first line	Carboplatin-paclitaxel with dostarlimab (RUBY) or pembrolizumab (NRG-GY018), continued as maintenance; durvalumab (DUO-E) is an alternative.	DostarlimabPembrolizumabDurvalumabCarboplatinPaclitaxel / nab-paclitaxelRUBY / ENGOT-EN6 / GOG-3031NRG-GY018 / KEYNOTE-868DUO-E / GOG-3041 / ENGOT-EN10Chemotherapy + PD-1/PD-L1 blockade, first-line advanced endometrial cancer		98
All comers	Recurrent after chemotherapy without prior immunotherapy	Single-agent dostarlimab or pembrolizumab, with durable responses in a large minority.	DostarlimabPembrolizumabImmune checkpoint inhibitorsMicrosatellite instability (MSI-H) / mismatch repair deficiency (dMMR)		99

Other settings

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Lynch carriers	Annual surveillance from the mid-thirties where offered, aspirin, and risk-reducing hysterectomy with salpingo-oophorectomy after childbearing.	Lynch syndromeGermline (hereditary) testingHysterectomy		94

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.