Quality of life in first-line trials for endometrial cancer: A systematic review
Valentina Tuninetti, Alberto Farolfi, Simona Butticè, Chiara Casadei, Roberta Danese, Antonino Musolino, Giorgio Valabrega, Massimo Di MaioObjective:
As treatment strategies evolve in advanced or metastatic endometrial cancer (EC), quality of life (QoL) has become a key parameter in evaluating therapeutic value. This systematic review summarizes QoL outcomes from pivotal trials that have shaped clinical practice in advanced EC.
Methods:
Data from phase II-III randomized trials of advanced or recurrent EC reporting patient-reported outcomes (PROs) were reviewed. Eligible studies assessed health-related QoL using validated instruments. The review focused on trials that met their primary endpoint and reported QoL or PROs in peer-reviewed publications and/or congress presentations. Data extraction and appraisal were conducted independently by the authors, and findings were synthesized narratively.
Results:
In the RUBY trial, dostarlimab plus chemotherapy prolonged time to deterioration and delayed permanent QoL decline in mismatch repair-deficient (dMMR)/microsatellite instability-high (MSI-H) patients. NRG-018 explored QoL in the mismatch repair-proficient (pMMR) cohort, with later planned time points still pending full publication. AtTEnd trial reported no clinically meaningful deterioration in global QoL with atezolizumab plus chemotherapy. In DUO-E, QoL was maintained with durvalumab-based strategies, with clinically meaningful physical functioning gains in the dMMR subgroup. In KEYNOTE-775, global QoL was broadly comparable between lenvatinib plus pembrolizumab and chemotherapy, although differences emerged in selected symptom domains.
Conclusion:
QoL provides a direct, patient-centered assessment of disease burden and treatment impact, complementing efficacy endpoints. However, QoL analyses remain inconsistently reported, delayed, and difficult to compare. Strengthening the integration and standardized reporting of PROs is essential to better define treatment value in advanced EC.