Second line chemotherapy for endometrial cancer

M Levin, MD — Wed, 20 Jun 2012 18:31:55 +0000

There is not much information on what to do after failure of first line chemotherapy in endometrial cancer. Currently, the standard of care for initial treatment of women who present with locally advanced disease or metastatic disease is anthracycline, taxane, and platinum combination. This is based on the Gynecologic Oncology Group (GOG) trial 177, which established the effectiveness of first-line paclitaxel, doxorubicin, and cisplatin (TAP) compared with doxorubicin and cisplatin (AP) in this population.

Ixabepilone has modest activity of limited duration as a second-line treatment in endometrial adenocarcinoma in those who largely received prior taxane therapy. In a recent phase II study, however, the activity of ixabepilone did not meet the pre-established threshold to move it forward in the GOG in this population.

In general, topotecan, ifosfamide, liposomal doxorubicin, and progestational agents have been generally used, although without strong literature-based support. Whether addition of Avastin to various combinations might change this situation is being investigated but second line chemotherapy for endometrial cancer at this time cannot be considered supported by medical literature.

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Tamoxifen, Endometrium and Hysterectomy

M Levin, MD — Tue, 19 Jun 2012 14:12:27 +0000

Tamoxifen has different effects on different tissues. Whereas it blocks estrogen in the breast, it has pro- estrogenic effects on bone and in the uterus. Working as an estrogen-like substance, it can cause dysfunctional uterine bleeding and endometrial thickening and very rarely, superficial, easily treatable, endometrial cancer and sarcoma. In a review of all NSABP breast cancer treatment trials, the rate of sarcoma in women treated with tamoxifen was 17 per 100,000 patient years versus none in the placebo group. Similarly, in a separate trial of high-risk women without breast cancer taking tamoxifen as part of a breast cancer prevention trial with a median follow-up of 6.9 years, there were four in the tamoxifen group versus none in the placebo group, translating into a very low risk. This is compared with the incidence of one to two per 100,000 patient years in the general population.

Some women develop endometrial thickening when taking tamoxifen. The significance of endometrial thickening is not clear. At one time, women were regularly subjected to regular screening, ultrasound and even intra-uterine biopsies. Experience had not borne out such an approach. Beyond a routine gynecologic examination eliciting any history of abnormal bleeding, it has been recommended that screening studies and procedures for detecting endometrial pathology in women taking tamoxifen should be left to the discretion of the individual gynecologist. Routine ultrasound screening is not recommended because of significant incidents of false-positive endovaginal ultrasound screening tests. Of course, any abnormal uterine bleeding should be completely evaluated.

There are no guidelines to recommend hysterectomy routinely for patients of tamoxifen. One guideline that has taken up this issue is this Society of Gynecologic Oncology pf Canada and it recommends: “In asymptomatic women on tamoxifen, a routine ultrasound for endometrial thickening should not be performed.” It does not recommend routine hysterectomy.

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Cancer Treatment Today » Endometrial Cancer

Second line chemotherapy for endometrial cancer

Tamoxifen, Endometrium and Hysterectomy