This protocol addresses endometrial carcinoma that has been classified as high risk, at stage IIIm through IVAm, in patients with confirmed mismatch repair deficiency (MMRd) — a molecularly distinct sub-population with specific management considerations.
High-risk endometrial carcinoma at stages IIIm–IVAm with mismatch repair deficiency (MMRd). This staging and molecular profile together define the specific clinical population for which this protocol applies.
In appropriately selected patients, a surgical cytoreductive approach — when complete macroscopic resection is achievable with acceptable morbidity and quality of life — forms part of the management strategy. The complete protocol specifies the full intervention sequence, additional treatment modalities, and decision criteria beyond this overview.
For patients with stage IIIm–IVAm MMRd endometrial carcinoma, adjuvant chemotherapy combined with an immune checkpoint inhibitor (with or without external beam radiotherapy) should be considered (II,B; figure 5).
In patients with stage III and IV endometrial carcinoma (including carcinosarcoma), surgical cytoreduction—including resection of suspicious lymph nodes—should be considered when complete macroscopic resection is feasible with an acceptable morbidity and quality of life, following full pre-operative staging and discussion by a multidisciplinary team (IV, B).
DOI: 10.1016/S1470-2045(25)00167-6
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