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作者信息

Alexandre Jérôme, Le Frère-Belda Marie-Aude, Angelergues Antoine, Ferron Gwenaël, Treilleux Isabelle, Gaillard Anne-Lise, Frenel Jean-Sébastien, You Benoît, Rouleau Etienne, Lortholary Alain, Ray-Coquard Isabelle, Joly Florence

机构信息

Service d'oncologie médicale, AP-HP-centre université de Paris cité, site Cochin, 123 boulevard de Port-Royal, 75014 Paris, France.

Service d'anatomie pathologie, AP-HP-centre université de Paris Cité, site HEGP, 20-40 rue Leblanc, 75015 Paris, France.

出版信息

Bull Cancer. 2023 Jun;110(6S):6S34-6S43. doi: 10.1016/S0007-4551(23)00332-6.

Abstract

Recommendations for clinical practice Nice/Saint-Paul-de-Vence 2022-2023 : Management of advanced/relapsing endometrial cancer Since the first recommendations in 2020 concerning metastatic and/or relapsed endometrial cancer, new treatment options have shown a benefit on patients' life expectancy, justifying their update. In first line, the choice will be made between chemotherapy with carboplatin/paclitaxel or hormone therapy with progestin, depending on tumor characteristics (histological type, grade, expression of hormone receptors, rate of progression). In case of a dMMR tumors, the use of immunotherapy within the framework of a therapeutic trial is an option. Beyond first-line chemotherapy, current standard treatment consists of the combination of pembrolizumab and lenvatinib, regardless of MMR status. Close clinical and biological monitoring is however necessary given the potential toxicity. Chemotherapy retains its place either as monotherapy (paclitaxel or doxorubicin) in the event of failure or contraindication to pembrolizumab-lenvatinib, or in combination with carboplatin in the event of a long free interval and pMMR tumor. The numerous ongoing clinical trials evaluating new therapeutic targets or strategies adapted to molecular or histological types should allow further improvements the prognosis of patients with metastatic endometrial cancer.

摘要

2022 - 2023年尼斯/圣保罗 - 德旺斯临床实践建议:晚期/复发性子宫内膜癌的管理 自2020年首次发布关于转移性和/或复发性子宫内膜癌的建议以来,新的治疗选择已显示出对患者预期寿命有益,因此有必要对其进行更新。一线治疗时,将根据肿瘤特征(组织学类型、分级、激素受体表达、进展速度)在卡铂/紫杉醇化疗或孕激素激素治疗之间做出选择。对于错配修复缺陷(dMMR)肿瘤,在治疗试验框架内使用免疫疗法是一种选择。一线化疗之外,目前的标准治疗是帕博利珠单抗和乐伐替尼联合使用,无论错配修复(MMR)状态如何。然而,鉴于潜在毒性,密切的临床和生物学监测是必要的。如果对帕博利珠单抗 - 乐伐替尼治疗失败或有禁忌,化疗可作为单药治疗(紫杉醇或阿霉素)保留其地位,或者在缓解期长且为错配修复功能正常(pMMR)肿瘤的情况下与卡铂联合使用。众多正在进行的评估新治疗靶点或适应分子或组织学类型策略的临床试验应能进一步改善转移性子宫内膜癌患者的预后。

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