Second line chemotherapy for endometrial cancer – pro

There is not much information on what to do after failure of first line chemotherapy in endometrial cancer. Currently, the standard of care for 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.

There is not much information on what to do after failure of first line chemotherapy in endometrial cancer. Ixabepilone has modest activity of limited duration as a second-line treatment in endometrial adenocarcinoma in this population who largely received prior taxane therapy. In a recent phase II study, the activity of ixabepilone did not meet the established bar to move it  forward in the GOG in this population.

At recurrence, topotecan, ifosfamide, liposomal doxorubicin, and progestational agents have been 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 endmetrial cancer at this time cannot be considered supported by medical literature.

Holland Frei Cancer Medicine 2009, Volume 8 By Waun Ki Hong, Robert C. Bast, William Hait, Donald W. Kufe, James F. Holland, Raphael E. Pollock, Ralph R. Weichselbaum, p. 1382

Ueda Y, Miyake T, Egawa-Takata T, Miyatake T, Matsuzaki S, Yokoyama T, Yoshino K, Fujita M, Enomoto T, Kimura T.
Second-line chemotherapy for advanced or recurrent endometrial carcinoma previously treated with paclitaxel and carboplatin, with or without epirubicin.Cancer Chemother Pharmacol. 2011 Apr;67(4):829-35.

Don S. Dizon, John A. Blessing, D. Scott McMeekin, Sudarshan K. Sharma, Paul DiSilvestro and Ronald D. Alvarez Phase II Trial of Ixabepilone As Second-Line Treatment in Advanced Endometrial Cancer: Gynecologic Oncology Group Trial 129-P JCO July 1, 2009 vol. 27 no. 19 3104-3108

Fleming G. Systemic chemotherapy for uterine carcinoma: metastatic and adjuvant. J Clin Oncol 2007;25:2983-2990

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