First-line treatments for advanced or recurrent endometrial cancer: Systematic literature review of clinical evidence

Novel therapies are driving meaningful changes to the management of endometrial cancer (EC). Herein, a systematic literature review was conducted to evaluate the efficacy and safety of first-line treatments for advanced/recurrent EC. Searches were conducted using multiple databases through October 26, 2023. In total, 108 records of 57 unique trials (48 of first-line therapies) met the inclusion criteria. Baseline characteristics varied by study, and sample sizes ranged from 28 to 1328. Median progression-free survival was reported in 28 trials (range, 1.9–18.8 months), median overall survival in 26 trials with mature data (range, 6.9–41 months), and safety in 21 trials evaluating first-line systemic therapy ± maintenance. The potentially high risk of adverse events may outweigh the suboptimal efficacy benefits reported for conventional chemotherapy or hormonal therapies. The safety and efficacy of immunotherapies identified within are expected to contribute to a paradigm shift in the management of primary advanced/recurrent EC. • The efficacy of conventional chemotherapy and hormonal therapies is suboptimal. • Increasing the number of agents used in combination increases toxicity. • Molecular profiling was limited but is increasing over time. • Progression-free survival was improved in recent immunotherapy + chemotherapy trials. • The standard of care is evolving for primary advanced/recurrent endometrial cancer.