Treatment Options for dMMR Endometrial Cancer

Some people with endometrial cancer have a specific subtype called dMMR. This stands for “deficient mismatch repair.” It means cells have trouble fixing DNA damage. Cancers with dMMR tend to have many DNA errors, which can make tumors grow and spread more quickly.¹

For people with dMMR endometrial cancer, previous treatments may not have worked or the cancer may have returned after previous treatment (recurrent cancer) or spread to other parts of the body (metastatic). The cancer is typically considered advanced at this point.^1,2

Treating dMMR endometrial cancer can be a challenge. But there are several options for managing the disease and improving quality of life. And treatment options continue to improve. Treatment for dMMR endometrial cancer is based on:^1-3

• The stage of the cancer
• Previous endometrial cancer treatment
• Your age and overall health
• Personal treatment preferences

Surgery

Surgery is generally the first step in treating endometrial cancer. For advanced cases, doctors may recommend removing the uterus, ovaries, and fallopian tubes. This type of surgery is called a total hysterectomy bilateral salpingo-oophorectomy (TH/BSO). Nearby lymph nodes also may be removed to check if the cancer has spread to them.³

Sometimes, surgeons may also remove visible cancer in other parts of the body. This is called debulking surgery. The goal is to reduce the amount of cancer, potentially making other treatments like chemotherapy or radiation more effective.³

Surgery may not be an option for everyone, especially those with recurrent or metastatic endometrial cancer. If the cancer has spread widely or if the person is too ill to undergo surgery, doctors may explore other treatment options.³

Chemotherapy

Chemotherapy (chemo) uses drugs to kill cancer cells or stop them from growing. This treatment is often recommended for advanced endometrial cancer, especially if the disease has spread to distant parts of the body.^3,4

Chemotherapy is usually given through an IV or a pill. It can be used alone. But it is often more effective when used in combination with other chemo drugs. It is typically given in cycles with rest periods in between them to allow the body to recover.^3,4

In advanced endometrial cancer, the goal of chemo is often to control the cancer and slow its progression. This treatment can be effective for shrinking tumors and reducing the chance of the cancer spreading.^3,4

Radiation

Radiation therapy uses high-energy rays to target and destroy cancer cells. It is often used after surgery to kill any remaining cancer cells or to treat areas where the cancer has spread. There are 2 main types of radiation therapy for endometrial cancer:^1,3,5

• External beam radiation delivers radiation from a machine outside the body.
• Brachytherapy places radioactive sources inside the body, near the cancer.

In advanced cases, radiation therapy may be used in combination with chemotherapy.⁴

Targeted therapy

Targeted therapy is a newer approach to treating cancer. It focuses on specific molecules or processes that cancer cells use to grow and spread. Chemotherapy affects both cancer cells and healthy cells. But targeted therapy aims to attack only cancer cells and minimize the impact on healthy cells. This may lead to fewer side effects than chemotherapy.⁶

Doctors may recommend targeted therapy for certain types of high-risk endometrial cancer. This treatment may be used in combination with other therapies. They are chosen based on the characteristics of the cancer. Some therapies may require special testing to see if you are eligible.⁶

Immunotherapy

Immunotherapy is often used when other treatments have not worked or for recurrent cancers. Immunotherapy is a treatment that uses your own immune system to fight cancer. Immunotherapy works by helping your immune system recognize and attack cancer cells.^1,2,7

Several immunotherapy drugs are available to treat advanced endometrial cancer. And more are being studied. Immunotherapy may be combined with chemo or targeted therapy drugs in certain situations.^1,2,7

Hormone therapy

Hormone therapy is used to slow the growth of certain types of endometrial cancer cells. Hormone therapy can be given as pills or injections. It is often combined with some form of other treatment, like chemotherapy.⁸

Hormone therapy can be used for endometrial cancer that has spread or returned after initial treatment. It may also be a treatment option for women with endometrial cancer who want to get pregnant in the future. This is because hormone therapy may spare their fertility.⁸

Make treatment decisions that are right for you

Choosing the right treatment for advanced endometrial cancer involves careful consideration. A team that may include oncologists, surgeons, and other specialists will work together to create a personal treatment plan for you.^2,3

Ideally, your doctor will discuss the goals of treatment along with each treatment’s potential benefits, possible side effects, and risks. You should feel comfortable asking questions and sharing your preferences. Support from family, friends, and community groups can also be helpful during this time.

Hope for the future

When it comes to treating advanced endometrial cancer, research continues to improve. Precision-based therapies and clinical trials offer hope for better survival rates. While more work is needed, researchers agree that a personalized approach is key to improving outcomes.^1,2