Advanced endometrial cancer in the gulf cooperation council: a modified-Delphi consensus on unmet needs, molecular...

Advanced endometrial cancer (EC), including primary unresectable stage III-IV, metastatic, and recurrent disease, is an increasing clinical challenge in the Gulf Cooperation Council (GCC). Rising cardiometabolic risk, heterogeneous referral pathways, variable access to molecular diagnostics, and inconsistent uptake of biomarker-driven therapy contribute to variation in care. This consensus aimed to identify GCC-specific unmet needs and develop regionally adapted recommendations for the diagnosis and management of advanced or recurrent EC.

A structured, modified Delphi process was conducted with 12 experts from Bahrain, Kuwait, Qatar, and the United Arab Emirates. Candidate statements were developed from a targeted PubMed literature review and evaluated through 2 rounds of anonymous voting using predefined consensus thresholds. A consensus was considered when voting reached a 75%-89% agreement, a strong consensus was defined as ≥90% agreement, and no consensus was defined as <75% agreement.

Consensus was achieved on 31 statements. The panel identified key regional gaps, including increasing EC burden, limited GCC-specific molecular and real-world data, inconsistent implementation of molecular testing, variable access to immunotherapy and targeted therapies, and delays in referral to specialized centers. GCC experts recommended routine molecular classification at diagnosis, standardized diagnostic work-up and staging aligned with FIGO 2023, multidisciplinary tumor board review before any clinical decision, carboplatin-paclitaxel plus immunotherapy as the preferred first-line standard for eligible patients, biomarker-informed treatment selection in the post-platinum setting, and early integration of supportive and palliative care. Additional priorities included clinician education, registry development, patient-reported outcomes, and implementation tools to improve real-world quality of care. Final recommendations were classified as international guideline-aligned, GCC-specific adaptation, or expert-opinion recommendation.

This consensus provides a practical, GCC-adapted framework to support more consistent, biomarker-informed, and multidisciplinary management of advanced or recurrent EC across the region.