Second line chemotherapy for endometrial cancer

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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