Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with endometrial cancer

Abstract

The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with endometrial cancer was published in 2022. It was therefore decided, by both the ESMO and the Indian Society of Medical and Paediatric Oncology (ISMPO), to convene a virtual meeting in July 2022 to adapt the ESMO 2022 guidelines to take into account the variations in the management of endometrial cancer in Asia. These guidelines represent the consensus opinion of a panel of Asian experts representing the oncological societies of China (CSCO), India (ISMPO), Indonesia (ISHMO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), the Philippines (PSMO), Singapore (SSO), Taiwan (TOS) and Thailand (TSCO). Voting was based on scientific evidence and was conducted independently of the current treatment practices and treatment access constraints in the different Asian countries, which were discussed when appropriate. The aim of this guideline manuscript is to provide guidance for the optimisation and harmonisation of the management of patients with endometrial cancer across the different regions of Asia, drawing on the evidence provided by Western and Asian trials whilst respecting the variations in clinical presentation, diagnostic practices including molecular profiling and disparities in access to therapeutic options, including drug approvals and reimbursement strategies.

Keywords: ESMO; Pan-Asian; endometrial cancer; guidelines; treatment.

Figure 1

Diagnostic algorithm for the integrated molecular endometrial cancer classification. dMMR, mismatch repair deficient; EC, endometrial cancer; MMR, mismatch repair; NSMP, no specific molecular profile; p53mut, p53 mutant; pMMR, mismatch repair proficient; POLE, DNA polymerase epsilon; POLEmut, DNA polymerase epsilon-ultramutated. ^aPathogenic POLE variants include p.Pro286Arg, p.Val411Leu, p.Ser297Phe, p.Ala456Pro and p.Ser459Phe.25. ^bMMR deficiency is defined by the loss of one or more MMR proteins (MLH1, PMS2, MSH2 and MSH6). ^cp53 immunohistochemistry is an acceptable surrogate marker for TP53 mutation status in MMR-proficient, POLE wild-type EC. Permission to use figure under a Creative Commons CC BY License, Wiley obtained by ESMO.

Figure 2

Stage I endometrial cancer: surgery. Burgundy box: general category or stratification; orange boxes: surgery; white box: other aspect of management. EC, endometrial cancer; EEC, endometrioid-type endometrial cancer; LNE, lymphadenectomy. ^aExcept in those restricted to polyps.

Figure 3

Stage I-IVA endometrial cancer: adjuvant therapy for low- and intermediate-risk patients. Burgundy boxes: general categories or stratification; green box: radiotherapy; white box: other aspects of management. dMMR, mismatch repair deficient; EC, endometrial cancer; EEC, endometrioid-type endometrial cancer; LVSI, lymphovascular space invasion; NSMP, no specific molecular profile; p53abn, p53 abnormal; POLEmut, polymerase epsilon-ultramutated; VBT, vaginal brachytherapy. ^aIf completely resected without residual disease.

Figure 4

Stage I-IVA endometrial cancer: adjuvant therapy for high-intermediate-risk and high-risk patients. Burgundy boxes: general categories or stratification; olive green boxes: combination of treatments or other systemic treatments. ChT, chemotherapy; dMMR, mismatch repair deficient; EBRT, external beam radiotherapy; EC, endometrial cancer; LVSI, lymphovascular space invasion; NSMP, no specific molecular profile; p53abn, p53 abnormal; RT, radiotherapy. ^aIf completely resected without residual disease.

Figure 5

Locoregional recurrent endometrial cancer. Burgundy box: general category; orange box: surgery; green boxes: radiotherapy; blue box: systemic anticancer therapy. Dotted arrow denotes optional follow-up therapy. EBRT, external beam radiotherapy; EC, endometrial cancer; RT radiotherapy; VBT, vaginal brachytherapy.

Figure 6

Metastatic endometrial cancer. Burgundy box: general category; blue boxes: systemic anticancer therapy. AI, aromatase inhibitor; AUC, area under the curve; ChT, chemotherapy; dMMR, mismatch repair deficient; EC, endometrial cancer; ICI, immune checkpoint inhibitor; ESMO-MCBS, European Society for Medical Oncology-Magnitude of Clinical Benefit Scale; MSI-H, microsatellite instability-high; MSS, microsatellite stable; pMMR, mismatch repair proficient. ^aIn patients eligible for further treatment after failure of platinum-based therapy. ^bESMO-MCBS v1.1 was used to calculate scores for new therapies/indications approved by the European Medicines Agency or Food and Drug Administration (FDA). The scores have been calculated by the ESMO-MCBS Working Group and validated by the ESMO Guidelines Committee. ^cFDA approval is restricted to patients whose tumours are not MSI-H or dMMR.