PDF(Pubmed)
Abstract：
UNASSIGNED: 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.
UNASSIGNED: 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%).
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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%).
UNASSIGNED: 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.
UNASSIGNED: 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.
摘要：
■子宫内膜癌在几个国家越来越受到关注，包括巴西,部分原因是人口老龄化,生育率下降，以及肥胖患病率的增加。尽管子宫内膜肿瘤在治疗改善方面落后于其他癌症类型，这些肿瘤的分子表征为新的治疗方法和治疗武器库的扩展铺平了道路。我们旨在帮助在巴西医疗机构中管理复发性或转移性子宫内膜癌患者的医学肿瘤学家。
■面板，由20名医学肿瘤学家组成，2021年11月召开会议，解决50个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共识水平分类为（1）共识（≥75％选择相同的答案），（2）多数票（50％至<75％），或(3)低于多数票(<50%)。
■就50个问题中的25个问题达成共识，而多数票出席了另外23个问题。主要建议包括对每位复发/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HER2选择一线治疗，并增加程序性死亡配体1（PD-L1）和激素受体（HRs）用于二线治疗；卡铂和紫杉醇是HER2阴性疾病一线治疗的首选方案。在HER2阳性疾病中加入曲妥珠单抗；派博利珠单抗加乐伐替尼作为二线的关键选择，与HER2、PD-L1或HR无关；以及关于不同合并症患者治疗选择的各种建议。
■尽管现有文献中存在差距，专家小组解决的绝大多数问题提供了足以为巴西和其他医疗保健环境相似的国家的临床实践提供信息的协议水平。
■面板，由20名医学肿瘤学家组成，2021年11月召开会议，解决50个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共识水平分类为（1）共识（≥75％选择相同的答案），（2）多数票（50％至<75％），或(3)低于多数票(<50%)。
■就50个问题中的25个问题达成共识，而多数票出席了另外23个问题。主要建议包括对每位复发/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HER2选择一线治疗，并增加程序性死亡配体1（PD-L1）和激素受体（HRs）用于二线治疗；卡铂和紫杉醇是HER2阴性疾病一线治疗的首选方案。在HER2阳性疾病中加入曲妥珠单抗；派博利珠单抗加乐伐替尼作为二线的关键选择，与HER2、PD-L1或HR无关；以及关于不同合并症患者治疗选择的各种建议。
■尽管现有文献中存在差距，专家小组解决的绝大多数问题提供了足以为巴西和其他医疗保健环境相似的国家的临床实践提供信息的协议水平。
