Greek researchers recently reported a response rate of nearly 75% in women with advanced or recurrent endometrial cancer who received a combination of chemotherapy and hormone therapy. The responses in 2 women were in fact complete and long lasting.
Cancer of the endometrium is characterized by the presence of cancer cells in the lining of the uterus, or womb. Treatment options for endometrial cancer depend on many factors, including the type, grade, and stage (extent of disease at diagnosis) of disease. The grade of cancer, that is, how and how quickly the cancer is likely to spread, is determined by how differentiated the cancer cells appear from normal cells when observed under a microscope. When the stage of endometrial cancer is such that it has spread outside the area of the uterus to other parts of the body, the disease is sometimes referred to as advanced or metastatic. When the cancer has been treated (usually with surgery, with or without radiation therapy) and it comes back, the disease is referred to as recurrent. Women who have advanced or recurrent endometrial cancer commonly receive either hormone therapy or chemotherapy to help relieve the symptoms of disease and prolong survival time.
The uterus is an organ that is highly sensitive to hormone levels, and thus the growth of endometrial cancer is also sensitive to the presence of hormones. Hormone therapy for endometrial cancer has long included the use of progesterones—such as hydroxyprogesterone, medroxyprogesterone, and megestrol—because the cancer cells have receptors for these agents. Individually, these hormones can produce response rates of 20 to 29%; however, they are more effective when combined with an antiestrogen drug called tamoxifen. Previous studies of this combination show response rates of up to 21%, with moderate side effects. In addition, cancer cells that appear well differentiated (lower grade) under the microscope respond better to progesterone therapy than do poorly differentiated (higher grade) cancer cells.
Chemotherapy can also benefit some persons with endometrial cancer, but there is a clear need for more effective regimens. The chemotherapy drugs most commonly used against this disease include doxorubicin, cisplatin, and paclitaxel. Recently, researchers in Greece treated women who had advanced or recurrent endometrial cancer with a combination of chemotherapy and hormone therapy.
Researchers treated 23 women with advanced or recurrent endometrial cancer, none of whom had received prior hormone therapy or chemotherapy. Ten of the women had undergone radiation therapy previously. The women received chemotherapy with carboplatin, methotrexate, and fluorouracil, as well as hormone therapy with medroxyprogesterone. Responses to this regimen were observed in 74% of patients, with 2 long-lasting complete responses. The average duration of the responses was more than 10 months, and the average survival time was more than 16 months. The treatment was administered on an outpatient basis and was well tolerated.
These researchers concluded that this chemotherapy/hormone therapy regimen was an active combination against advanced and recurrent endometrial cancer. Persons who have this type of disease may wish to talk with their doctor about the risks and benefits of participating in a clinical trial (research study) in which new chemotherapy/hormone therapy combinations are being studied.
(Oncology, Vol 56, No 3, pp 198-201, 1999)