Analysis of healthcare provider treatment of advanced endometrial cancer and concordance with expert recommendations in 2023 vs 2022.

person Kristen M. Rosenthal Clinical Care Options, LLC, Reston, VA info_outline Kristen M. Rosenthal, Megan Cartwright, Jerfiz D. Constanzo, Hye Sook Chon, Linda R. Duska, Ebony R. Hoskins, Ritu Salani

Authors person Kristen M. Rosenthal Clinical Care Options, LLC, Reston, VA info_outline Kristen M. Rosenthal, Megan Cartwright, Jerfiz D. Constanzo, Hye Sook Chon, Linda R. Duska, Ebony R. Hoskins, Ritu Salani Organizations Clinical Care Options, LLC, Reston, VA, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, University of Virginia Health System, Charlottesville, VA, MedStar Washington Hospital Center, Washington, DC, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA Abstract Disclosures Research Funding GSK Background: Practice patterns are rapidly evolving for first-line (1L) treatment (tx) of advanced endometrial cancer (aEC). In 2022, we created an online interactive decision support tool [clinicaloptions.com/Endometrialtool] for healthcare professionals (HCPs) with case-specific recommendations from 5 gynecologic oncology experts for treating 1L and second-line (2L) aEC. In 2023, NCCN guidelines included a recommendation of carboplatin/paclitaxel plus an immune checkpoint inhibitor (ICI) for 1L tx of aEC. Working with the experts, we updated the tool to its current 2023 version. Here, we compare planned tx reported by HCPs using the 2023 tool vs expert recommendations and compare practice patterns for the 2023 vs 2022 tools. Methods: To use the 2023 tool, HCPs entered key characteristics, including the tx setting; tumor histology (1L only); actionable biomarker status (dMMR/MSI-H, HER2, ER/PgR); prior tx, response, and response duration (2L only); and planned tx. After HCPs reported their planned tx, the tool showed expert recommendations for that scenario and asked if the recommendations changed the planned tx. Results: From September 2023 to January 2024, 123 HCPs entered 181 cases into the tool, of which 45% were in the 1L setting. HCPs reported a biomarker status of "unknown” in 30% of 1L cases. In 2022, all experts recommended platinum-based chemotherapy (plt CT) ± bevacizumab for 1L HER2-negative cases, whereas all experts in 2023 recommended plt CT + ICI for 1L cases with dMMR/MSI-H (Table). There was less consensus on adding ICI to plt CT when 1L cases had no actionable biomarker. In 2023, the tx planned by HCPs matched ≥1 expert in 29/54 (54%) of 1L cases—a modest improvement from 2022, when matches occurred in 19/42 (45%) of 1L cases. In 2023, match rates were highest for dMMR/MSI-H cases (50%-86%), followed by cases without actionable biomarker (36%-50%) or HER2+ (33%-67%). Overall, 88% of HCPs indicated that the tool recommendations either changed or confirmed their tx plan. Conclusions: HCPs are challenged to optimally manage 1L aEC in concordance with expert recommendations and/or NCCN guidelines. Detailed analyses of HCP tx vs expert recommendations in the 1L and 2L settings and 2023 vs 2022 practice patterns will be presented. 1L: Histology Biomarker Status Most Common Expert Recommendation Agreement Among 5 Experts, n (%) Match Between HCP Intended Tx and Recommendations From ≥1 Expert, No. Matches/Cases (%) Carcinosarcoma dMMR/MSI-H Plt CT + ICI 5 (100) 1/2 (50) Carcinosarcoma HER2 Plt CT + trastuzumab 5 (100) 1/3 (33) Carcinosarcoma None Plt CT + ICI 3 (60) 3/6 (50) Serous dMMR/MSI-H Plt CT + ICI 5 (100) 6/7 (86) Serous HER2 Plt CT + trastuzumab 5 (100) 2/3 (67) Serous None Plt CT + ICI 3 (60) 4/11 (36) Other* dMMR/MSI-H Plt CT + ICI 5 (100) 8/13 (62) Other* None Plt doublet CT 3 (60) 4/9 (44) *Clear cell, endometrioid, un-/dedifferentiated.