de Andrade Diocésio Alves Pinto, Guimarães Andréa Paiva Gadelha, de Melo Andréia Cristina, Nogueira-Rodrigues Angélica, Gomes Larissa Müller, Scaranti Mariana, Maia Joyce Maria Lisboa, Morelle Alessandra Menezes, Santos Candice Amorim de Araújo Lima, Souza Cristiano de Pádua, de Freitas Daniela, Callegaro Filho Donato, Paulino Eduardo, Júnior Elge Werneck Araújo, Pimenta Juliana Martins, Dos Santos Marcela Bonalumi, de Almeida Michelle Samora, Souza Ronaldo Pereira, Cabral Samantha, Maluf Fernando Cotait
Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil.
InORP Oncoclínicas Group, Ribeirão Preto, Brazil.
Front Oncol. 2023 Mar 9;13:1133277. doi: 10.3389/fonc.2023.1133277. eCollection 2023.
Endometrial 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.
The 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%).
Consensus 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.
Despite 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.
子宫内膜癌在包括巴西在内的多个国家日益受到关注，部分原因是人口老龄化、生育率下降以及肥胖患病率上升。尽管子宫内膜肿瘤在治疗改善方面落后于其他癌症类型，但这些肿瘤的分子特征为新疗法和治疗手段的扩展铺平了道路。我们旨在帮助在巴西医疗环境中管理复发性或转移性子宫内膜癌患者的医学肿瘤学家。
由20名医学肿瘤学家组成的小组于2021年11月召开会议，回答50道关于分子检测和治疗选择的多项选择题。我们将小组成员之间的一致程度分为：（1）共识（≥75%选择相同答案）；（2）多数票（50%至<75%）；或（3）少于多数票（<50%）。
50道题中有25道达成了共识，另有23道题获得了多数票。关键建议包括：对每例复发性/转移性子宫内膜癌患者进行分子检测；根据微卫星不稳定性和人表皮生长因子受体2（HER2）选择一线治疗方案，二线治疗增加程序性死亡配体1（PD-L1）和激素受体（HRs）检测；对于HER2阴性疾病，一线治疗首选卡铂和紫杉醇，HER2阳性疾病加用曲妥珠单抗；无论HER2、PD-L1或HRs状态如何，帕博利珠单抗联合仑伐替尼作为二线治疗的关键方案；以及针对不同合并症患者治疗选择的各种建议。
尽管当前文献存在空白，但该小组讨论的绝大多数问题达成的一致程度足以指导巴西及其他医疗环境相似国家的临床实践。
