Treatment Patterns and Outcomes Among Patients With Advanced or Recurrent Endometrial Cancer Initiating First-Line Therapy in the United States

Abstract

Background: Patients with advanced or recurrent endometrial cancer (EC) typically have limited treatment options and poor long-term survival outcomes following first-line therapy. Real-world treatment patterns and survival outcomes data are limited for patients in this setting. Objectives: The objective of this retrospective study was to describe real-world demographics, clinical characteristics, treatment patterns, and overall survival among patients in the United States with primary advanced or recurrent EC who initiated at least 1 line of therapy (LOT). Methods: Patients with a diagnosis of primary advanced or recurrent EC in a real-world database from January 1, 2013, to July 31, 2021, were included. The date for inclusion was the date of EC diagnosis documentation; patients were indexed for treatment patterns and outcomes at the start of the first LOT and at the start of each subsequent LOT they initiated. Data were stratified by subgroups of patients who had mismatch repair deficient (dMMR) or microsatellite instability-high (MSI-H) tumors. Results: A total of 1961 patients who received at least 1 LOT were included. Most patients in this cohort, and the dMMR/MSI-H subgroup, received a platinum combination as first-line treatment, with carboplatin-paclitaxel being the most common regimen. Only 53% of patients who received first-line treatment subsequently received second-line therapy. Of the patients who received at least 1 LOT, use of immunotherapy in the second-line setting was more common in the dMMR/MSI-H subgroup. Median overall survival ranged from 14.1 to 31.8 months across the 5 most frequently used first-line treatment regimens in the ≥1 LOT cohort and became shorter with each subsequent LOT. Discussion: The use of platinum-based chemotherapy for first-line treatment of advanced or recurrent EC predominates in the real-world setting, despite the poor long-term survival outcomes associated with most of these regimens. Conclusions: Patients with recurrent/advanced EC have a poor prognosis, highlighting the need for therapies with more durable benefits.

Keywords: United States; chemotherapy; endometrial cancer; first-line therapy; real-world outcomes; survival; treatment outcomes.

Figure 1.. Attrition in (A) Overall Cohort and (B) ≥1 LOT Cohort

Abbreviations: EC, endometrial cancer; LOT, line of therapy.

Figure 2.. Top 5 Treatment Regimens at 1L (A and B) and 2L (C and D)

More than 5 regimens are presented for the calculation for the dMMR/MSI-H subgroup in panel D. This is due to the equal percentage of patients treated with doxorubicin pegylated liposomal and megestrol (joint fourth regimens) and everolimus plus letrozole and megestrol plus tamoxifen (joint fifth regimens). Abbreviations: 1L, first-line; 2L, second-line; dMMR, mismatch repair deficient; LOT, line of therapy; MSI-H; microsatellite instability-high.

Figure 3.. Overall Survival in ≥1 LOT Cohort by (A) Top 5 1L Regimens and (B) by LOT

The top 5 1L regimens included cisplatin; however, as the median OS for cisplatin (N=65) was not reported, only the top 4 regimens are included in panel A. Panel A: IQR for carboplatin plus paclitaxel, 9.5-67.7 months; IQR for cisplatin, 28.1 months -NR; IQR for megestrol, 13.4 months -NR; IQR for bevacizumab plus carboplatin plus paclitaxel, 12.3-66.6 months; IQR for carboplatin plus docetaxel, 6.4-50.6 months. Panel B: IQR for LOT1, 9.2-73.0 months; IQR for LOT2, 6.4-46.6 months; IQR for LOT3, 5.4-35.5 months. Abbreviations: 1L, first-line; IQR, interquartile range; LOT, line of therapy; NR, not reported; OS, overall survival.