Transforming Treatment Pathways for Endometrial Cancer

In this interview, Floortje Backes, MD, The Ohio State University College of Medicine, discusses advancements in novel treatments, the impact of molecular classifications, evolving surgical approaches, barriers to standardizing care, and critical research priorities in endometrial cancer management.

Please introduce yourself by stating your name, title, organization, and relevant professional experience.

Floortje Backes, MD: I am Dr Floortje Backes. I am a professor in the Department of Obstetrics and Gynecology and director of clinical research for the Division of Gynecologic Oncology at The Ohio State University College of Medicine and The James Cancer Hospital and Solove Research Institute.

What recent advancements in novel treatments for endometrial cancer have shown the most promise in improving patient outcomes and how are these treatments changing the standard pathways of care for endometrial cancer?

Dr Backes: Immunotherapy—used as a single agent, in combination with chemotherapy, or in combination with other targeted agents—has significantly improved the outcomes. Profound and durable responses, as well as the long duration of complete responses, suggest the potential for cure. Of course, longer follow-up will be needed.

How are molecular classifications (eg, POLE mutations, p53 status) influencing treatment decisions and pathways in endometrial cancer, and what implications do they have for clinical decision-making and cost-effectiveness?

Dr Backes: We are learning a lot about how these subsets of endometrial cancer behave differently and how they respond to treatments in distinct ways. Multiple studies are ongoing to determine optimal treatment strategies for these cancers. For example, POLE-mutated cancers may not need any additional treatment, while p53-mutated tumors may derive greater benefit from chemotherapy.

How has sentinel lymph node mapping impacted surgical approaches and outcomes in endometrial cancer management?

Dr Backes: With sentinel lymph node mapping in endometrial cancer management, we see less lymphedema and complications from full lymph node resections, as sentinel lymph node mapping enables more precise targeting of the lymph nodes with the highest risk of metastasis.

What barriers exist in standardizing treatment pathways for endometrial cancer, particularly in resource-limited settings?

Dr Backes: In some areas, molecular testing and targeted therapies may not be available. Certainly, endometrial cancer treatment has become increasingly complex and personalized, moving away from a one-size-fits-all approach. The treatment of endometrial cancer requires specialized knowledge and training to provide the best care for our patients, so it is important that patients see a gynecologic oncologist.

What research areas in endometrial cancer do you believe are most critical for improving survival and quality of life?

Dr Backes: A research area in endometrial cancer that I believe is critical for improving survival and quality of life is the management of side effects, especially since patients are on treatment and maintenance therapy longer.