Late-Breaking Abstract 1: Randomized phase III noninferiority trial of first line chemotherapy for metastatic or recurrent endometrial carcinoma: A Gynecologic Oncology Group study

Miller, David S.; Filiaci, Virginia L.; Fleming, Gini F.; Mannel, Robert S.; Cohn, David E.; Matsumoto, Takashi; Tewari, Krishnansu S.; DiSilvestro, Paul; Pearl, M.; Zaino, Richard J.

doi:10.1016/j.ygyno.2012.03.034

Cited by 241 publications

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“…Although most of these trials used four to six cycles of doxorubicin/platinum-based regimens, carboplatin plus paclitaxel is the most commonly used adjuvant therapy based on results in more advanced disease [20]. When chemoradiotherapy is administered, radiation is variably used before chemotherapy, after chemotherapy, or in a "sandwich" fashion, with three cycles of chemotherapy given before radiotherapy and three cycles given after radiotherapy.…”

Section: Adjuvant Chemotherapymentioning

confidence: 99%

“…The preferred frontline chemotherapy regimen is carboplatin/paclitaxel. Although the randomized phase III trial comparing this regimen with the previous standard of cisplatin/doxorubicin/paclitaxel (GOG 209) has been reported only in abstract form [20], the results of that trial, along with results of a number of nonrandomized phase II trials and the convenience and tolerability of the carboplatin/paclitaxel doublet, have led to its widespread use.…”

Section: First-line Chemotherapymentioning

confidence: 99%

“…Progression-free survival was 14 months in both arms, with overall survival of 32 months of the TC arm versus 38 months in the TAP arm (HR, 1.01). Statistically significant grade II or greater toxicities were seen more frequently with TAP, including sensory neuropathy, metabolic derangements, vomiting, diarrhea, thrombocytopenia, and other hematologic toxicities [20]. As a result, TC has become the standard front-line chemotherapy used for recurrent or metastatic endometrial cancer, as well as adjuvant therapy.…”

Section: First-line Chemotherapymentioning

confidence: 99%

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Chemotherapy for Endometrial Cancer in Adjuvant and Advanced Disease Settings

Bestvina

Fleming

2016

The Oncologist

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Level I evidence exists for use of adjuvant chemotherapy in stage IIIC endometrial cancer (positive lymph nodes), although results of randomized trials have varied. Chemotherapy is also often recommended for high-risk subsets of stage I disease, such as serous carcinomas, although prospective trial data to validate this practice are lacking. Carboplatin plus paclitaxel is the current standard regimen, based on extrapolation of data from the metastatic setting. Several clinical trials have compared adjuvant pelvic radiotherapy alone to a combination of radiotherapy and chemotherapy with mixed results. One of the largest of these trials, Postoperative Radiation Therapy in Endometrial Carcinoma 3 (PORTEC-3), has completed accrual and is awaiting data maturation. Metastatic disease is not curable. For tumors of low-grade endometrioid histology with a prolonged time to recurrence, endocrine therapy with a progestin-based regimen is appropriate. Chemotherapy will be used in most other cases, and the standard first-line regimen is carboplatin and paclitaxel. Few chemotherapy agents have been shown to produce meaningful response rates in the second-line setting. Molecularly targeted therapies such as mTOR inhibitors and antiangiogenic agents including bevacizumab have been studied but their role in the armamentarium remains uncertain. The Oncologist 2016; 21:1250-1259 Implications for Practice: Following surgical resection and staging for endometrial cancer, adjuvant chemotherapy with carboplatin and paclitaxel can be administered to patients with a high risk for recurrence. This includes patients with stage IIIC disease with positive lymph nodes, and high-risk subsets of stage I disease such as serous carcinomas. In the metastatic setting, endocrine therapy can be considered, particularly for patients with lower-grade disease and a prolonged time to recurrence. Combined therapy with carboplatin and paclitaxel is the standard of care used for front-line chemotherapy. Antiangiogenic agents are clearly active, but how they should be integrated into treatment is not yet determined. Immunotherapy is a promising direction for patients with mismatch repair-deficient or polymerase «-mutated tumors.

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Section: Adjuvant Chemotherapymentioning

confidence: 99%

Section: First-line Chemotherapymentioning

confidence: 99%

Section: First-line Chemotherapymentioning

confidence: 99%

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Chemotherapy for Endometrial Cancer in Adjuvant and Advanced Disease Settings

Bestvina

Fleming

2016

The Oncologist

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“…9,10 Other hormonal drugs such as tamoxifen and aromatase inhibitors are associated with a similar response rate of about 10%. [11][12][13] Carboplatin and paclitaxel have been shown to be non-inferior to paclitaxel, cisplatin and doxorubicin 14 but chemotherapy is known to cause myelosuppression, which makes it an unsuitable option in women with bone marrow metastases and cytopenias. In our patient with grade 3 endometrial cancer with bone marrow infiltration and platelet counts persistently < 50 x 10 9/ l, we had no suitable evidence-based treatment options available.…”

Section: Discussionmentioning

confidence: 99%

Endometrial cancer with bone marrow metastases: a management dilemma

Guzha

Adams

Rogers

et al. 2017

Southern African Journal of Gynaecological Oncology

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A case is presented of a 67-year-old woman referred to the authors' institution with endometrioid endometrial cancer with a leucoerythroblastic blood film and marked thrombocytopenia. On further evaluation, it was confirmed that she had grade 3 endometrial cancer with bone marrow involvement (FIGO stage IVB). This is a rare complication of endometrial cancer and her marked thrombocytopenia severely limited her treatment options.

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“…Another significant prognostic factor in patients with endometrial cancer was shown to be the histopathological subtype; while cases diagnosed with type I endometrial cancer (endometroid tumors) report a favorable prognosis, women diagnosed with type-II endometrial cancer (serous cell tumors or clear cell tumors) will experience a poorer outcome. However, it seems that applying the principles of debulking surgery can significantly improve the outcomes of these cases (5,6).…”

mentioning

confidence: 99%

Debulking Surgery for High-grade Serous Endometrial Cancer with Disseminated Peritoneal Lesions

Bacalbaşa

Bălescu

Filipescu

2017

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Abstract. Endometrial cancer is one of the most common malignancies in postmenopausal womenEndometrial cancer, one of the most common gynecologic malignancies, usually affects postmenopausal women (1). The most commonly reported sign consists of postmenopausal vaginal bleeding, which, most often, determines further investigation. In such a case, the patient is usually diagnosed in early stages of the disease, submitted to surgery with curative intent and reports an excellent result in terms of survival (2-4). However, in certain cases, vaginal bleeding is not seen, with the patient presenting diffuse abdominal pain, weight loss or asthenia. As a result, a longer period of time will pass between the onset of the symptoms and the moment of establishing the right diagnosis. Therefore, the patient will be diagnosed when disseminated lesions are already present with, unfortunately, a poorer outcome. It has been widely demonstrated that, while patients diagnosed in early stages of the disease report a 5-year survival of up to 85%, cases diagnosed in advanced stages will report a 5-year survival rate of less than 15%. Another significant prognostic factor in patients with endometrial cancer was shown to be the histopathological subtype; while cases diagnosed with type I endometrial cancer (endometroid tumors) report a favorable prognosis, women diagnosed with type-II endometrial cancer (serous cell tumors or clear cell tumors) will experience a poorer outcome. However, it seems that applying the principles of debulking surgery can significantly improve the outcomes of these cases (5, 6). Case ReportA 60-year-old, nulliparous patient presented with diffuse abdominal pain, asthenia and weight loss. The preoperative imaging studies revealed the presence of a diffuse endometrial thickening in association with the presence of diffuse peritoneal thickening, mesenteric nodules and ascites. The patient was submitted to endometrial biopsy that revealed the presence of a high-grade endometrial serous carcinoma. After the specific preoperative preparation, the patient was submitted to debulking surgery, a total hysterectomy with bilateral adenexectomy, total colectomy, partial cystectomy with cystoraphy, pelvic, para-aortic lymph node dissection, total omentectomy, pelvic, parietal and left diaphragmatic peritonectomy, with a R0 resection being achieved (Figures 1-3). The terminal ileum was exteriorized in terminal right ileostomy. The postoperative course was uneventful, with the patient being discharged in the fifth postoperative day. The urinary catheter was removed in the 21th postoperative day. Histopathological and immunohistochemical studies revealed the presence of a high-grade serous endometrial carcinoma with three pelvic positive nodes. The patient was submitted to six cycles of adjuvant chemotherapy. Three months after ending the adjuvant treatment, she was submitted to a control computed tomography scan that revealed absence of recurrent disease. Therefore, the continuity of the digestive tract was 719

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Late-Breaking Abstract 1: Randomized phase III noninferiority trial of first line chemotherapy for metastatic or recurrent endometrial carcinoma: A Gynecologic Oncology Group study

Cited by 241 publications

References 0 publications

Chemotherapy for Endometrial Cancer in Adjuvant and Advanced Disease Settings

Chemotherapy for Endometrial Cancer in Adjuvant and Advanced Disease Settings

Endometrial cancer with bone marrow metastases: a management dilemma

Debulking Surgery for High-grade Serous Endometrial Cancer with Disseminated Peritoneal Lesions

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