Top Line: How does mismatch repair status influence the risk of recurrence for early stage endometrial cancer?
The Study: In a recent molecular analysis of the PORTEC trials, over a quarter of endometrial cancers were mismatch repair deficient (dMMR). In that study, rates of recurrence for dMMR disease fell in an intermediate range between those with favorable POLEmut disease and those with less favorable p53 abnormal disease. Locoregional RFS was numerically higher (95.7% v 90.3%) with EBRT versus no adjuvant therapy for those with dMMR disease, although that difference was not statistically significant. Other studies have found that dMMR disease carries a worse prognosis than MMR proficient disease. This large retrospective study evaluated 744 patients with stage I-II endometrioid endometrial adenocarcinoma who received adjuvant EBRT +/- VBT (25%) or VBT alone (75%). Overall, 31.5% had dMMR disease, and dMMR status was significantly associated with recurrence free survival independent of other risk factors. Compared to those with pMMR, dMMR patients had significantly worse RFS (74.3% v 88.6%). The authors noted that patients with dMMR disease in the current study had worse clinicopathologic features than patients in the PORTEC study. More data is needed to better understand how to integrate classic clinicopathologic risk factors and molecular data when selecting adjuvant therapy for endometrial cancer.
TBL: In this retrospective study of patients receiving adjuvant radiation for early stage endometrial cancer, dMMR status was associated with worse recurrence free survival. | Hathout, Int J Radiat Oncol Biol Phys 2024
The Study: In a recent molecular analysis of the PORTEC trials, over a quarter of endometrial cancers were mismatch repair deficient (dMMR). In that study, rates of recurrence for dMMR disease fell in an intermediate range between those with favorable POLEmut disease and those with less favorable p53 abnormal disease. Locoregional RFS was numerically higher (95.7% v 90.3%) with EBRT versus no adjuvant therapy for those with dMMR disease, although that difference was not statistically significant. Other studies have found that dMMR disease carries a worse prognosis than MMR proficient disease. This large retrospective study evaluated 744 patients with stage I-II endometrioid endometrial adenocarcinoma who received adjuvant EBRT +/- VBT (25%) or VBT alone (75%). Overall, 31.5% had dMMR disease, and dMMR status was significantly associated with recurrence free survival independent of other risk factors. Compared to those with pMMR, dMMR patients had significantly worse RFS (74.3% v 88.6%). The authors noted that patients with dMMR disease in the current study had worse clinicopathologic features than patients in the PORTEC study. More data is needed to better understand how to integrate classic clinicopathologic risk factors and molecular data when selecting adjuvant therapy for endometrial cancer.
TBL: In this retrospective study of patients receiving adjuvant radiation for early stage endometrial cancer, dMMR status was associated with worse recurrence free survival. | Hathout, Int J Radiat Oncol Biol Phys 2024