At the ASCO 2024, four clinically very important abstracts in endometrial cancer were presented. Long-term survival for primary hormonal therapy in premenopausal patients with clinical stage I disease versus primary surgery that were included in the National Cancer Database was reported. All had grade 1 or 2 endometrioid cancer and were between 18 and 49 years of age. They either received primary hysterectomy or primary hormonal therapy. In patients < 40 years, no difference in survival was found between the two groups. However, patients between 40 and 49 years of age who received primary hormonal therapy showed a significantly inferior survival compared to the hysterectomy group (10-year survival of 97% versus 79%, respectively). The SIENDO study reported the long-term follow-up of selinexor maintenance in patients with TP53 wild-type (wt) advanced or recurrent endometrial cancer who previously achieved remission following taxane-carboplatin chemotherapy. Selinexor inhibits XPO1 which is a multiclient nuclear exporter. Women received either selinexor 80 mg PO weekly or placebo. The median progression-free survival in the selinexor and the placebo group was 28 months versus 5 months, respectively (HR 0.44; p = 0.0005). Selinexor resulted in more grade >= 3 toxicities: 13% nausea, 3% vomiting, 4% diarrhea, 5% asthenia, 8% fatigue, 10% thrombocytopenia, 20% neutropenia, and 7% anemia. In a phase II study in mismatch repair deficient (dMMR) endometrial cancer, combined vibostolimab and pembrolizumab resulted in complete and partial remissions in 13 and 53% of patients, respectively. Grade 3 or 4 immune-mediated adverse events included severe skin reactions, adrenal insufficiency, pneumonitis, and hypophysitis. A phase II study of fulvestrant plus abemaciclib in hormone-receptor-positive advanced endometrial cancer resulted in partial remission in 44% and stable disease in 20% of the 27 patients, respectively.
