Background: Until recently, recurrent or advanced endometrial cancer (aEC) patients in Europe had limited treatment options, with no consensus on standard of care in such settings. Approval of novel targeted therapies in 2021 are changing the treatment landscape. However, there is little real-world evidence among aEC patients in Europe. The objective of our study was to evaluate real-world treatment patterns and clinical outcomes in aEC patients who progressed following prior systemic therapy (FPST) in clinical practice in Europe. Methods: The ECHO-EU is a multicenter, retrospective chart review study in United Kingdom (UK), Germany (GE), Italy (IT) and Spain (SP). Adult women diagnosed with aEC who received at least one prior systemic therapy and progressed between July 1, 2016 – June 30, 2019, were included. De-identified patient data extracted by treating oncologists from patients’ medical records included patient demographics, clinical and treatment characteristics, and clinical outcomes. Kaplan-Meier analyses were performed to estimate real-world overall survival (OS). Results: A total of 379 (UK=101, GE=88, IT=100, SP=90) eligible aEC patients were included in the analysis. At aEC diagnosis, patients’ median age was 69 years, 97% were White/Caucasian and most prevalent histology was endometrioid carcinoma (58%). Molecular characterization of tumors including microsatellite instability/mismatch repair (MSI/MMR) status was performed in only 37% of patients. Metastases were observed in 56% of the patients at diagnosis. Median duration of follow up from aEC diagnosis was 24 months. The majority (95%) of patients initiated 1^st line with chemotherapy (most commonly with platinum chemotherapy and paclitaxel). As 2^nd line therapy, 81% received mono or combination chemotherapy, and 19% received hormonal therapy. Doxorubicin was the most frequently used agent (45%) in 2^nd line, and 16% of patients were re-treated with platinum therapy. At last follow-up, the majority (90%) of patients discontinued 2^nd line treatment, mostly due to disease progression (54%). Median duration of 2^nd line therapy was 5 months (95% Confidence Interval [CI]: 4-5). Median OS from initiation of 2^nd line therapy was 11 months (95% CI: 10-13). Estimated probability of OS from initiation of 2^nd line therapy at 6, 12, and 24 months were 70%, 45%, and 30%, respectively. Conclusions: Our study finds thatin Europe prior to mid-2019, available treatment options were sub-optimal for aEC patients FPST, leading to poor prognosis. The utilization of MSI/MMR testing for molecular characterization of tumors was low and needs to increase. There was a significant unmet need for novel therapies that improve clinical outcomes in this patient population. Future studies evaluating treatment patterns and clinical outcomes with more recently approved treatments are warranted.