Mali Barbi, Medical Oncologist at Northwell Health Cancer Institute, shared a post on X:
“We are moving beyond the “one-size-fits-all” era in Endometrial Cancer. The PORTEC4a trial in The Lancet Oncology marks a definitive transition from anatomical staging to molecular as the primary guide for treatment. Biology is now the definitive map for the patient journey.
The PORTEC4a trial used the tumor’s own biological “source code” for treatment decisions:
– Favorable (POLE mut): Exceptional outcomes-safely spares 46% of patients from any radiation.
– Unfavorable (p53 abn/substantial LVSI): High-risk features demanding intensified intervention.
– Intermediate (MMRd/NSMP): A complex landscape where precision dictates the approach.
Precision requires rigor. While the PORTEC4a trial met its vaginal endpoint, we must consider the full recurrence picture:
Isolated vaginal relapse: ~4%
Total recurrence: ~12%
64% of vaginal failures occurred alongside pelvic or distant spread. We cannot treat a systemic molecular profile with local solutions alone. High-risk biology demands systemic therapy.
The Patient’s Voice. Patients have long asked: “Do I really need this radiation?” PORTEC-4a provides evidence to say “No” to nearly half of women with favourable profiles. By de-escalating when biology allows, we protect quality of life. By intensifying when biology warns us, we can protect survival.
The paradigm has shifted to a molecular-first standard: reflex molecular testing for all patients at diagnosis. Beyond local control-prioritize overall disease control. Science-driven, patient-centered, and molecularly led.”
Title: Molecular profile-based adjuvant treatment for women with high-intermediate risk endometrial cancer (PORTEC-4a): results of a randomised, open-label, phase 3, multicentre, non-inferiority trial
Authors: Anne Sophie V M van den Heerik, Nanda Horeweg, Marie A D Haverkort, Nienke Kuijsters, Stefan Kommoss, Friederike L A Koppe, Marlies E Nowee, Henrike Westerveld, Maria A A De Jong, Filip Frühauf, Jeltsje S Cnossen, Jan Willem M Mens, Jannet C Beukema, Cyrus Chargari, Charles Gillham, Ina M Jurgenliemk-Schulz, Katrien Vandecasteele, Moritz Hamann, Mandy Kiderlen, Annette Staebler, Hans W Nijman, Bastiaan G Wortman, Elefteria Asteinidou, Stephanie M de Boer, Wilbert B van den Hout, Karen W Verhoeven-Adema, Remi A Nout, Hein Putter, Tjalling Bosse, Carien L Creutzberg
Read The Full Article on The Lancet Oncology
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