Cancers au Féminin, Actualités permanentes en Senologie

FIGO 2023 CLASSIFICATION, THE PATHOLOGIST’S VIEWPOINT

Dr. Camille PASQUESOONE — 2025-07-31

The molecular classification of endometrial carcinoma is now standardized, with prognostic and therapeutic impact based on scientific evidence. This classification is integrated into: the WHO classification, the ESGO-ESTRO-ESP multidisciplinary guidelines
and the new FIGO 2023 classification. The molecular classification of endometrial carcinoma is now standardized with a prognostic and therapeutic impact based on scientific evidence. This classification is integrated into: the WHO classification, the ESGO ESTRO-ESP multidisciplinary guidelines and the new FIGO 2023 classification.

THE NEW FIGO 2023 CLASSIFICATION AND ITS IMPACT ON DAY-TO-DAY TREATMENT STRATEGY. THE SURGEON’S POINT OF VIEW

Dr. Léa ROSSI — 2025-07-31

The new FIGO classification of endometrial cancers was published in 2023. It has newly included the presence of lymph-vascular space invasion, grade, and histological subtype.
Let’s seize the opportunity to provide an update on surgical strategies in the management of these cancers.
We will also discuss specific cases and ongoing issues.

MANAGEMENT OF LOCALIZED AND LOCALLY ADVANCED ENDOMETRIAL CANCERS IN 2025: THE PLACE OF RADIOTHERAPY AND BRACHYTHERAPY

Dr. Nicolas VIAL — 2025-07-31

The current value of molecular biology data allowed to introduce a new characterization for localized and locally advanced endometrial cancers. In the same time, the FIGO staging has been recently updated.
Their incorporation into practice recommandations defined by ESGO-ESMO-ESP 2021 should more specify risk levels associated with each oncological situation, and therefore more precise indications of adjuvant therapies such as radiotherapy and/or brachytherapy.

SYSTEMIC MANAGEMENT OF LOCALIZED ENDOMETRIAL CANCER: NEWS AND PERSPECTIVES

Dr. Pauline CORBAUX — 2025-07-31

The therapeutic approach of localized endometrial cancer is mainly based on surgery, combined with adjuvant treatment adapted to the risk of recurrence, which may combine brachytherapy, external beam radiotherapy, chemotherapy and chemoradiotherapy.
The assessment of this risk takes into account clinical and histological prognostic criteria, as well as the molecular characteristics of the tumour as defined by the TCGA classification. When indicated, current adjuvant systemic treatment of endometrial cancer is based mainly on platinum-based chemotherapy, possibly following the PORTEC-3 regimen (chemotherapy and chemoradiotherapy). While the prognostic value of the molecular classification of endometrial cancer is well established, its theranostic impact is the cornerstone of current adjuvant clinical trials. The identification of new biomarkers, predictive of the efficacy of targeted therapies, is also a major focus, without neglecting the role of supportive care.

FIRST-LINE TREATMENT FOR ADVANCED OR METASTATIC ENDOMETRIAL CANCER IN 2025

Dr. Mathilde SAINT-GHISLAIN — 2025-07-31

Endometrial cancer is the second most common gynecological cancer after breast cancer. TCGA analysis has classified these tumors into four subtypes with distinct molecular profiles: POLEmutated, MMRd, TP53m, and NSMP. These tumor subtypes have different prognoses that are currently not considered in first-line metastatic treatment. Treatment of locally advanced or metastatic disease is based on a chemotherapy/anti-PD1 combination: Carboplatin, Paclitaxel and Dostarlimab. This combination demonstrated a 6-month increase in progression-free survival (PFS) in the RUBY trial. Hormone therapy remains a first-line option for a very limited population (slowly progressive tumors with high hormone receptor expression). The question of a therapeutic de-escalation in the MMRd population is raised by the DOMENICA trial currently recruiting where Dostarlimab is compared to Carboplatin Taxol.

LOCALLY ADVANCED OR METASTATIC ENDOMETRIAL CANCER IN 2025: WHAT SYSTEMIC MANAGEMENT STRATEGIES BEYOND FIRST-LINE?

Dr. Jean-David FUMET — 2025-07-31

Endometrial cancer is one of the most common gynecologic malignancies, primarily affecting post menopausal women. While most cases are diagnosed at an early stage, approximately 10- 15% progress to metastatic or recurrent disease, associated with a poor prognosis. Since 2023, chemoimmunotherapy has become the standard first-line treatment, particularly with the addition of PD-1/PD-Ll inhibitors to carboplatin-paclitaxel chemotherapy. However, second line and beyond therapeutic strategies remain crucial for improving patient survival.

In the second-line setting, the lenvatinib-pembrolizu mab combination has demonstrated significant benefits in progression-free and overall survival compared to standard chemotherapy, although its efficacy after first-line immunotherapy remains to be determined. Doxorubicin and hormone therapy remain options, though with limited efficacy. Emerging therapeutic approaches include antibody-drug conjugates (ADCs) targeting HER2, Trop2, and FRα, which have shown promising objective response and disease control rates. Additionally, novel immune checkpoint inhibitors targeting LAG-3, TIGIT, and TIM-3, as well as innovative combinations involving cellular therapy and therapeutic vaccines, are currently under clinical investigation.
The future of advanced endometrial cancer treatment relies on optimizing therapeutic sequencing and identifying predictive biomarkers to personalize systemic management strategies.