Role of Genomic and Molecular Biology in the Modulation of the Treatment of Endometrial Cancer: Narrative Review and Perspectives

Abstract

Endometrial cancer (EC) is one of the most common gynecological malignancies in Western countries. Traditionally, loco-reginal dissemination and histological characteristics are the main prognostic factors. Nowadays, molecular and genomic profiling showed exciting results in terms of prognostication. According to the data provided by The Cancer Genome Atlas and other studies, molecular and genomic profiling might be useful in identifying patients al low, intermediate, and high risk of recurrence. However, data regarding the therapeutic value are scant. Several prospective studies are ongoing to identify the most appropriate adjuvant strategy in EC patients, especially for those with positive nodes and low volume disease. The molecular classification has offered the possibility to improve the risk stratification and management of EC. The aim of this review is to focus on the evolution of molecular classification in EC and its impact on the research approach and on clinical management. Molecular and genomic profiling might be useful to tailor the most appropriate adjuvant strategies in apparent early-stage EC.

Novel Insights into Molecular Mechanisms of Endometrial Diseases

“…Molecular characteristics found in EC with worse prognosis are Estrogen receptor (ER) positivity, phosphatidylInositol 3-Kinase/protein-kinase B (PI3K/AKT) mutations, progesterone receptor (PR) positivity, L1CAM positivity. These results suggest that it would be useful to perform a more detailed molecular analysis especially in high-risk ECs, which represent a subclass with complex and heterogeneous characteristics, refining therapeutic management in clinical practice [ 21 , 23 , 24 , 25 , 26 ]. Furthermore, EC generally affects patients with a higher rate of comorbidity, elderly or obese, the assessment of the state of women’s frailty is fundamental to customize treatment strategies and reducing the morbidity rate therapy-related [ 27 , 28 , 29 ].…”

Sparing Is Caring: Hormonal Retreatment in Women with Recurrent Endometrial Cancer after Fertility Preservation Management—A Single Centre Retrospective Study

“…Furthermore, the treatment of these patients was not randomized, and heterogeneous patients received a variety of oral and intrauterine combinations. Lastly, we did not evaluate the molecular classifications and the expression of estrogen and progesterone receptors [ 58 , 59 , 60 , 61 ].…”

The Role of Selected Adipocytokines in Ovarian Cancer and Endometrial Cancer

“…It is well known that in endometrial and ovarian cancer, DNA repair systems are disrupted. The most common defect in ovarian cancer concerns the homologous recombination (HR) DNA repair system [ 65 ], while impairment of the DNA mismatch repair (MMR) system is more frequent in endometrial cancer [ 66 ]. Obesity influenced DSB repair systems and nucleotide excision repair (NER) [ 64 ].…”