OpenOnco · Treatment Plan

Treatment plan — Endometrial carcinoma

PLAN-VERIFIED-ENDOMETRIAL-L2-ENDOMETRIAL_2L_PEMBRO_LENVA_PM-V1 · v1 · 2026-07-15

Patient

VERIFIED-ENDOMETRIAL-L2-ENDOMETRIAL_2L_PEMBRO_LENVA_PM · Algorithm: ALGO-ENDOMETRIAL-2L

DiagnosisEndometrial carcinoma

MOH / ICD-10C54

ICD-O-38380/3; C54.1

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks

Biomarker	Variant	ESCAT	Evidence	Clinical significance	Drugs	Sources
No clinically actionable variants matched in this profile.

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-ENDOMETRIAL-2L-PEMBRO-LENVA-PMMR

Regimen

Pembrolizumab + Lenvatinib (KEYNOTE-775) — 2L pMMR endometrial

Drugs + NSZU

Pembrolizumab (DRUG-PEMBROLIZUMAB) 200 mg IV q3w (alternatively 400 mg IV q6w) · IV until progression / unacceptable toxicity / max 35 cycles (~2 years) · IV ⚠ NSZU — not for this indication
Lenvatinib (DRUG-LENVATINIB) 20 mg PO once daily continuous · Continuous PO daily · PO ⚠ NSZU — not for this indication

Hard contraindications

CI-PEMBROLIZUMAB-AUTOIMMUNE

Reason

Primary current-line option selected by ALGO-ENDOMETRIAL-2L at step 2.

Other current-line alternatives (1 tracks)

Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.

Aggressive plan

Indication

IND-ENDOMETRIAL-2L-DOSTARLIMAB-DMMR

Regimen

Dostarlimab monotherapy (GARNET) — 2L+ dMMR endometrial

Drugs + NSZU

Dostarlimab (DRUG-DOSTARLIMAB) 500 mg IV q3w (cycles 1-4) then 1000 mg IV q6w (cycle 5+) · IV per protocol — until progression / unacceptable toxicity / max 2 years · IV ✗ Not registered in UA

Hard contraindications

CI-PEMBROLIZUMAB-AUTOIMMUNE

Reason

Current-line alternative presented for HCP consideration

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks

ID	Name	Priority	Category	Where to order	Needed for
TEST-CBC	Complete Blood Count with Differential	Critical	lab	—	all tracks
TEST-CECT-CAP	CECT chest/abdomen/pelvis	Critical	imaging	—	all tracks
TEST-CMP	Comprehensive Metabolic Panel	Critical	lab	—	all tracks
TEST-DMMR-IHC	MMR proteins IHC (MLH1 / MSH2 / MSH6 / PMS2)	Critical	histology	CSD Lab ✓ (code TBC)	all tracks
TEST-ECHO	Echocardiography	Standard	imaging	—	desired (standard)

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Patient with active or incompletely controlled pre-existing autoimmune or inflammatory disease (sarcoidosis, rheumatoid arthritis, IBD, SLE, autoimmune hepatitis, inflammatory myopathy, myasthenia gravis, or similar) is considered for immune checkpoint inhibitor (ICI) therapy — elevated risk of immune-related adverse events (irAE) flare or de-novo grade 3-4 irAE. Requires specialist (rheumatology / pulmonology / gastroenterology) pre-treatment review; prefer lower-irAE-burden backbone when options exist (pembrolizumab mono > ipilimumab+nivolumab).
Pre-existing autoimmune disease is present in ~10-15% of patients eligible for ICI therapy; historically excluded from pivotal trials. Real-world data (Abdel-Wahab 2018, 3557 pts) shows 55% experienced irAE flare and ~29% required…
RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISKSRC-SITC-ICI-IRAEMANAGEMENT-2021SRC-ESMO-ICI-TOXICITY-2022
Frailty profile precluding standard carbo+pacli ± pembro / dostarlimab in advanced/recurrent endometrial: ECOG ≥3, OR age ≥75 with ≥2 comorbidities, OR composite (age ≥70 + albumin <3.0 + Charlson ≥3), OR explicit "unfit for combination chemotherapy". Endometrial cancer median age at diagnosis is ~63 with rising incidence in elderly.
Frail elderly options: single-agent carboplatin (well tolerated, ORR 20-30%), weekly paclitaxel, or hormonal therapy (megestrol acetate / medroxyprogesterone) for ER/PR+ low-grade tumors. Pembrolizumab / dostarlimab monotherapy for…
RF-ENDOMETRIAL-FRAILTY-AGESRC-NCCN-UTERINE-2025SRC-ESMO-ENDOMETRIAL-2022
Cardiac dysfunction (LVEF <50%) — limits anthracycline OR trastuzumab (HER2+ serous variant).
HER2+ serous endometrial subset eligible for trastuzumab + chemo.
RF-ENDOMETRIAL-ORGAN-DYSFUNCTIONSRC-NCCN-UTERINE-2025SRC-ESMO-ENDOMETRIAL-2022

CONTRA-AGGRESSIVE

Hard contraindications to escalation

Pembrolizumab (and other PD-1/PD-L1 inhibitors) augment T-cell responses; in patients with active autoimmunity or post-transplant immunosuppression, this can precipitate severe organ-specific flares (colitis, hepatitis, pneumonitis, transplant rejection) that may be fatal or require transplant loss. CI-PEMBROLIZUMAB-AUTOIMMUNE

What NOT to do

Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity

Standard plan (IND-ENDOMETRIAL-2L-PEMBRO-LENVA-PMMR)

Do not prescribe without MMR/MSI testing — dMMR patients receive single-agent ICI preferentially.
Do not ignore baseline + serial BP — Grade ≥3 hypertension in >30% of patients; antihypertensive prophylaxis from day 1.
Do not forget to check proteinuria each cycle — lenvatinib VEGFR blockade.
Do not prescribe in active autoimmune disease — irAE will progress uncontrollably.
Do not continue at Grade ≥3 irAE without permanent discontinuation consideration.
Do not combine with warfarin without INR monitoring — increased bleeding risk.
Do not start lenvatinib ≤1 wk before or ≤2 wk after surgery — wound healing delay.
Do not ignore Grade ≥3 diarrhea / hand-foot — dose-reduction mandatory (20→14→10→8 mg).

Aggressive plan (IND-ENDOMETRIAL-2L-DOSTARLIMAB-DMMR)

Do not prescribe without confirmed dMMR / MSI-H status — efficacy in pMMR is limited.
Do not prescribe in active autoimmune disease — irAE will progress uncontrollably.
Do not continue at Grade ≥3 irAE without permanent discontinuation consideration.
Do not use after prior ICI-exposure (RUBY/NRG-GY018 era 1L) — no data on reuse, consider pembro+lenva or chemo re-challenge.
Do not forget Lynch syndrome screening (germline testing for MMR genes) for all dMMR patients — affects family + future tumor surveillance.
Do not ignore ICI-pneumonitis at the onset of dyspnea — HRCT + corticosteroids.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Pembrolizumab + Lenvatinib (KEYNOTE-775) — 2L pMMR endometrial

21-day cycles × Pembrolizumab up to 35 cycles (~2 yr); lenvatinib until progression / intolerance

Aggressive plan

Induction · Dostarlimab monotherapy (GARNET) — 2L+ dMMR endometrial

21-day cycles × Until progression / unacceptable toxicity / max ~2 years

MDT brief

Discussion questions (2, 0 blocking)

OQ-LDH-CURRENT
What is the current LDH? Marker of tumor burden and transformation.
LDH is part of the prognostic indices of indolent lymphomas.
→ hematologist
OQ-BIOMARKER-DMMR-IHC
What is the status of Mismatch repair protein expression by IHC (BIO-DMMR-IHC)? It is required by track(s): IND-ENDOMETRIAL-2L-DOSTARLIMAB-DMMR. Expected value: deficient (loss of MLH1/MSH2/MSH6/PMS2).
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ pathologist

MDT talk tree (3 steps)

#	Owner	Topic	Action
1	hematologist	Staging / disease burden	What is the current LDH? Marker of tumor burden and transformation.
2	pathologist	Biomarker status	What is the status of Mismatch repair protein expression by IHC (BIO-DMMR-IHC)? It is required by track(s): IND-ENDOMETRIAL-2L-DOSTARLIMAB-DMMR. Expected value: deficient (loss of MLH1/MSH2/MSH6/PMS2).
3	clinical_pharmacist	Specialist review	Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.

Skills (recommended) — for consideration (1)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.

Data quality

Usable with caveats. No critical default-track gap was found, but the MDT should review the listed caveats before final sign-off.

Biomarker coverage: 0/1 known (0%), 1 missing, 0 default-track gaps
Unevaluated RedFlags: RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK, RF-CASCADE-LYNCH-FDR-POSITIVE, RF-CHRONIC-SEVERE-OBESITY-BMI40-PREVENTION, RF-CHRONIC-T2DM-CANCER-RISK-PREVENTION, RF-COWDEN-CONFIRMED-CARRIER, RF-COWDEN-FAMILY-HISTORY-SUSPICION, RF-ENDOMETRIAL-FIT-FOR-LENVATINIB-COMBO, RF-ENDOMETRIAL-FRAILTY-AGE, RF-ENDOMETRIAL-HIGH-RISK-BIOLOGY, RF-ENDOMETRIAL-INFECTION-SCREENING, RF-ENDOMETRIAL-ORGAN-DYSFUNCTION, RF-ENDOMETRIAL-TRANSFORMATION-PROGRESSION, RF-IATROGENIC-COMBINED-HRT-PREVENTION, RF-IATROGENIC-TAMOXIFEN-ENDOMETRIAL-PREVENTION, RF-LIFESTYLE-OBESITY-CANCER-PREVENTION, RF-LIFESTYLE-SEDENTARY-PREVENTION, RF-LIFESTYLE-SUGARY-BEVERAGES-PREVENTION, RF-LYNCH-CONFIRMED-CARRIER, RF-LYNCH-FAMILY-HISTORY-SUSPICION, RF-POLE-POLD1-ENDOMETRIAL-LOW-RISK, RF-REPRODUCTIVE-BREAST-ENDOMETRIAL-PREVENTION, RF-REPRODUCTIVE-OCP-LONG-TERM, RF-REPRODUCTIVE-PCOS-ENDOMETRIAL-PREVENTION

Missing biomarker	Label	MDT owner	Default track	Required by	Next action
`BIO-DMMR-IHC`	Mismatch repair protein expression by IHC	pathologist	no	IND-ENDOMETRIAL-2L-DOSTARLIMAB-DMMR	Verify result, method, specimen, and report date before sign-off. Expected/constraint: deficient (loss of MLH1/MSH2/MSH6/PMS2)

Technical MDT skill metadata (1/16 activated in this plan)

All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).

Specialist	skill_id	Version	Last reviewed	Domain
Cellular therapy specialist (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	cellular_therapy
Clinical pharmacist	`clinical_pharmacist`	v0.1.0	2026-04-25	clinical_pharmacy
Hematologist / oncohematologist	`hematologist`	v0.1.0	2026-04-25	hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)	`hematopathologist`	v0.1.0	2026-04-25	hematopathology
Infectious disease / hepatology	`infectious_disease_hepatology`	v0.1.0	2026-04-25	infectious_diseases
Medical oncologist (solid-tumor chemotherapist)	`medical_oncologist`	v0.1.0	2026-04-25	solid_oncology
Molecular geneticist / molecular oncologist	`molecular_geneticist`	v0.1.0	2026-04-25	molecular_oncology
Palliative care	`palliative_care`	v0.1.0	2026-04-25	palliative_care
Pathologist (general)	`pathologist`	v0.1.0	2026-04-25	pathology
Primary care / family physician	`primary_care`	v0.1.0	2026-04-25	primary_care
Psycho-oncologist	`psychologist`	v0.1.0	2026-04-25	psychosocial
Radiation oncologist	`radiation_oncologist`	v0.1.0	2026-04-25	radiation_oncology
Radiologist	`radiologist`	v0.1.0	2026-04-25	diagnostic_imaging
Social worker / case manager	`social_worker_case_manager`	v0.1.0	2026-04-25	psychosocial
Surgical oncologist	`surgical_oncologist`	v0.1.0	2026-04-25	surgical_oncology
Transplant specialist (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	cellular_therapy

Sources cited

SRC-ESMO-ENDOMETRIAL-2022: ESMO-ESGO-ESTRO Endometrial Consensus (2022)
SRC-NCCN-UTERINE-2025: NCCN Uterine Neoplasms (2025.v2)

Experimental options (clinical trials)

Third plan track — open-enrollment trials from ClinicalTrials.gov. Render-time metadata; engine selection is not affected by this block (CHARTER §8.3). Last synced: 2026-07-15.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT07285044	The Cancer Connected Access and Remote Expertise Beyond Walls Program to Provide In-Home Cancer Treatment and Improve Treatment Satisfaction in Cancer Patients Living in the Florida Panhandle and Surrounding Areas	PHASE2	RECRUITING	Mayo Clinic	—	Small N (<50) Single country
NCT06547840	A Study of MOv18 IgE in Patients With Solid Tumours That Express Folate Receptor Alpha	PHASE1	RECRUITING	Epsilogen Ltd	—	Phase 1 only Small N (<50) Single country
NCT07690540	DETERMINANTS OF IMMUNOTHERAPY EFFICACY IN ENDOMETRIAL CANCER	NA	RECRUITING	European Institute of Oncology	—	Single country
NCT06925724	A Study of Ivonescimab in People With Endometrial and Cervical Cancers	PHASE2	RECRUITING	Memorial Sloan Kettering Cancer Center	—	Surrogate endpoint only Single country
NCT07397624	Endoscopic Suture Gastroplasty (ESG) for Treatment of Obese Patients With Endometrial Cancer	N/A	RECRUITING	Centro di Riferimento Oncologico - Aviano	—	Single country
NCT06502743	First-line Carboplatin and Paclitaxel in Combination With Pembrolizumab, Followed by Maintenance Pembrolizumab With or Without Nesuparib, in Patients With Newly Diagnosed Advanced or Recurrent MMR-proficient (pMMR) Endometrial Cancer	PHASE2	RECRUITING	Yonsei University	—	Surrogate endpoint only Single country
NCT07400835	Evaluation of DNA Methylation Markers for Endometrial Cancer Risk-stratification Using Patient-collected Urine and Vaginal Samples and Clinician-collected Cervical Samples From Women With Postmenopausal Bleeding	N/A	RECRUITING	University of Aarhus	—	Single country
NCT06366347	ALPINE: Maintenance Letrozole/Abemaciclib	PHASE2	RECRUITING	Dana-Farber Cancer Institute	—	Small N (<50) Surrogate endpoint only Single country
NCT06686043	HPV Vaccine, Imiquimod, and Metformin Combination Trial	PHASE2	RECRUITING	Baylor College of Medicine	—	Surrogate endpoint only Single country
NCT06409052	Endometrial Cancer, Risk Factors and Prevention Strategies: Perspectives of Patients and At-Risk Women	N/A	RECRUITING	M.D. Anderson Cancer Center	—	Small N (<50) Single country

Verify recruitment status directly with the trial site. ctgov data can lag behind current UA-site status.

Option availability in Ukraine

Per-track UA registration · NSZU · cost · access pathway. Render-time metadata; engine selection does not depend on these fields (CHARTER §8.3).

Option	UA registration	NSZU	Cost orientation	Access pathway
Standard plan Pembrolizumab + Lenvatinib (KEYNOTE-775) — 2L pMMR endometrial (REG-PEMBRO-LENVATINIB-ENDOM)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Aggressive plan Dostarlimab monotherapy (GARNET) — 2L+ dMMR endometrial (REG-DOSTARLIMAB-MONO-ENDOM) 1/1 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT07285044 The Cancer Connected Access and Remote Expertise Beyond Walls Program to Provide In-Home Cancer Treatment and Improve Treatment Satisfaction in Cancer Patients Living in the Florida Panhandle and Surrounding Areas No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06547840 A Study of MOv18 IgE in Patients With Solid Tumours That Express Folate Receptor Alpha No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07690540 DETERMINANTS OF IMMUNOTHERAPY EFFICACY IN ENDOMETRIAL CANCER No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06925724 A Study of Ivonescimab in People With Endometrial and Cervical Cancers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07397624 Endoscopic Suture Gastroplasty (ESG) for Treatment of Obese Patients With Endometrial Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06502743 First-line Carboplatin and Paclitaxel in Combination With Pembrolizumab, Followed by Maintenance Pembrolizumab With or Without Nesuparib, in Patients With Newly Diagnosed Advanced or Recurrent MMR-proficient (pMMR) Endometrial Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07400835 Evaluation of DNA Methylation Markers for Endometrial Cancer Risk-stratification Using Patient-collected Urine and Vaginal Samples and Clinician-collected Cervical Samples From Women With Postmenopausal Bleeding No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06366347 ALPINE: Maintenance Letrozole/Abemaciclib No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06686043 HPV Vaccine, Imiquimod, and Metformin Combination Trial No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06409052 Endometrial Cancer, Risk Factors and Prevention Strategies: Perspectives of Patients and At-Risk Women No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-07-15.

plan_id: PLAN-VERIFIED-ENDOMETRIAL-L2-ENDOMETRIAL_2L_PEMBRO_LENVA_PM-V1 | version: 1 | generated: 2026-07-15T13:33:22.831187+00:00

Per FDA non-device CDS positioning (CHARTER §15): Outpatient oncology treatment planning to support tumor-board discussion. Not a medical device; not for autonomous clinical decision-making.

Per FDA non-device CDS positioning (CHARTER §15): Both treatment options below are presented for review. The engine's selection of a 'recommended' default does not constitute a clinical decision. Final treatment selection requires HCP judgment incorporating information not available to the system.

This document is an informational resource supporting tumor-board discussion (per CHARTER §11). It is not a system that makes clinical decisions. Every recommendation must be verified by the treating physician.