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Treatment of Advanced Stage and Recurrent Endometrial Cancer in Elderly Women

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Management of Gynecological Cancers in Older Women

Abstract

Most women who develop endometrial cancer are postmenopausal and over 40 % are over the age of 65. As the population ages, the burden of endometrial cancer is likely to increase. Age remains a poor prognostic factor with older women often presenting with higher stage and adverse pathology features with subsequent higher recurrence risk and worse survival. Though there is limited data on direct efficacy and toxicity for elderly patients, many significant trials in gynecologic oncology have naturally included older women. Treatment options for elderly women in the advanced and recurrent setting include combination chemotherapy, hormonal therapy, radiation therapy and combined treatment modalities. Balancing the comorbid conditions in the elderly population with treatment tolerance remain challenging for the treating oncologist.

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References

  1. Howlader N, Noone AM, Krapcho M, et al., editors. SEER cancer statistics review, 1975–2008, Bethesda: National Cancer Institute. http://seer.cancer.gov/csr/1975_2008/, based on November 2010 SEER data submission, posted to the SEER web site, 2011.

  2. Ahmed A, Zamba C, DeGeest K, Lynch CF. The impact of surgery on survival of elderly women with endometrial cancer in the SEER program from 1992-2002. Gynecol Oncol. 2008;111(1):35–40.

    Article  PubMed  Google Scholar 

  3. Ueda S, Kapp DS, Cheung MK, et al. Trends in demographic and clinical characteristics in women diagnosed with corpus cancer and their potential impact on the increasing number of deaths. Am J Obstet Gynecol. 2008;198(2):218.e1–6.

    Article  Google Scholar 

  4. Gayar OH, Robbins JR, Parikh K, et al. Hysterectomy for uterine adenocarcinoma in the elderly: tumor characteristics and long term outcome. Gynecol Oncol. 2011;123:71–5.

    Article  PubMed  Google Scholar 

  5. Mundt AJ, Waggoner S, Yamada SD, et al. Age as a prognostic factor for recurrence in patients with endometrial carcinoma. Gynecol Oncol. 2000;79:79–85.

    Article  PubMed  CAS  Google Scholar 

  6. Fleming ND, Lentz SE, Cass I, et al. Is older age a poor prognostic factor in stage I and II endometrioid endometrial adenocarcinoma? Gynecol Oncol. 2011;120:189–92.

    Article  PubMed  Google Scholar 

  7. Wright JD, Lewin SN, Medel NIB, et al. Endometrial cancer in the oldest old: tumor characteristics, patterns of care and outcome. Gynecol Oncol. 2011;122:69–74.

    Article  PubMed  Google Scholar 

  8. McMeekin DS, Alektiar KM, Sabbatini PJ, Zaino RJ. Corpus: epithelial tumors. In: Barakat R, Markman M, Randall ME, editors. Principles and practice of gynecologic oncology. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2009.

    Google Scholar 

  9. NCCN Clinical Practice Guidelines in Oncology. Uterine Neoplasms. Version 3.2012. www.nccn.org

  10. Partridge EE, Shingleton H, Menck H. The National Cancer Database report on endometrial cancer. J Surg Oncol. 1996;61:111–23.

    Article  PubMed  CAS  Google Scholar 

  11. Wegner RE, Beriwal S, Heron DE, et al. Definitive radiation therapy for endometrial cancer in medically inoperable elderly patients. Brachytherapy. 2010;9(3):260–5.

    Article  PubMed  Google Scholar 

  12. Sutton G, Axelrod JH, Bundy BT, et al. Whole abdominal radiotherapy in the adjuvant treatment of patients with stage III and IV endometrial cancer: a Gynecologic Oncology Group Study. Gynecol Oncol. 2005;97:755–63.

    Article  PubMed  Google Scholar 

  13. Citron JR, Sutton H, Yamada SD, et al. Pathologic stage I-II endometrial carcinoma in the elderly: radiotherapy indications and outcome. Int J Radiat Oncol Biol Phys. 2004;59(5): 1432–8.

    Article  PubMed  Google Scholar 

  14. Pignon T, Horiot JC, Bolla M, et al. Age is not a limiting factor in radical radiotherapy in pelvic malignancies. Radiother Oncol. 1997;42:117–9.

    Article  Google Scholar 

  15. Creutzberg CL, van Putten WLJ, Koper PCM, for the PORTEC study group, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage I endometrial carcinoma: multicenter randomized trial. Lancet. 2000;355:1404–11.

    Article  PubMed  CAS  Google Scholar 

  16. Keys HM, Roberts JA, Brunetto VL, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92:744–51.

    Article  PubMed  Google Scholar 

  17. Nout RA, Smit VT, Putter H, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open label, non inferiority, randomised trial. Lancet. 2010;375: 816–23.

    Article  PubMed  CAS  Google Scholar 

  18. Randall ME, Filiaci VL, Muss H, et al. Randomized phase III trial of whole-abdominal ­irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2006;24(1):36–44.

    Article  PubMed  CAS  Google Scholar 

  19. Homesley HD, Filiaci V, Gibbons SK, et al. A randomized phase III trial in advanced endometrial carcinoma of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: a Gynecologic Oncology Group study. Gynecol Oncol. 2009;112:543–52.

    Article  PubMed  CAS  Google Scholar 

  20. Thigpen JT, Brady MF, Homesley HD, et al. Phase III trial of doxorubicin with or without cisplatin in advanced endometrial carcinoma: a gynecologic oncology group study. J Clin Oncol. 2004;22:3902–8.

    Article  PubMed  CAS  Google Scholar 

  21. Fleming GF, Filiaci VL, Bentley RC, et al. Phase III randomized trial of doxorubicin  +  cisplatin versus doxorubicin  +  24-h paclitaxel  +  filgrastim in endometrial carcinoma: a Gynecologic Oncology Group study. Ann Oncol. 2004;15:1173–8.

    Article  PubMed  CAS  Google Scholar 

  22. Mould DR, Fleming GF, Darcy KM, Spriggs D. Population analysis of a 24-h paclitaxel infusion in advanced endometrial cancer: a Gynecologic Oncology Group study. Br J Clin Pharmacol. 2006;62(1):56–70.

    Article  PubMed  CAS  Google Scholar 

  23. Fleming GF, Brunetto VL, Cella D, et al. Phase III trial of doxorubicin plus cisplatin with or without paclitaxel: a Gynecologic Oncology Group study. J Clin Oncol. 2004;22(11):2159–66.

    Article  PubMed  CAS  Google Scholar 

  24. Fleming GF, Fowler JM, Waggoner SE, et al. Phase I trial of dose escalating paclitaxel combined with fixed doses of cisplatin and doxorubicin in advanced endometrial cancer and other gynecologic malignancies: a Gynecologic Oncology Group Study. J Clin Oncol. 2000;19(4):1021–9.

    Google Scholar 

  25. Hoskins PJ, Swenerton KD, Pike JA, et al. Paclitaxel and carboplatin, alone or with irradiation, in advanced or recurrent endometrial cancer. J Clin Oncol. 2001;20(19):4048–53.

    Google Scholar 

  26. Nakamura T, Onishi Y, Yamamoto F, et al. Evaluation of paclitaxel and carboplatin in patients with endometrial cancer [Japanese]. Gan to Kagaku Ryoho [Jpn J Cancer Chemother]. 2000;27(2):257–62.

    CAS  Google Scholar 

  27. Miller D, Filaci V, Fleming G et al. Randomized phase III noninferiority trial of first line chemotherapy for metastatic or recurrent endometrial carcinoma: A Gynecologic Oncology Group Study. Gynecol Oncol. 2012; 125:771–3. (Abstract)

    Article  Google Scholar 

  28. Lincoln S, Blessing JA, Lee RB, Rocereto TF. Activity of paclitaxel as second-line chemotherapy in endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2003;88(3):277–81.

    Article  PubMed  CAS  Google Scholar 

  29. Fracasso PM, Blessing JA, Molpus KL, Adler LM, Sorosky JI, Rose PG. Phase II study of oxaliplatin as second-line chemotherapy in endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2006;103:523–6.

    Article  PubMed  CAS  Google Scholar 

  30. Garcia A, Blessing J, Nolte S, Mannel R. A phase II evaluation of weekly docetaxel (NSC #628503) in the treatment of recurrent or persistent endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2008;111(1):22–6.

    Article  PubMed  CAS  Google Scholar 

  31. Muggia FM, Blessing JA, Sorosky J, Reid GC. Phase II trial of the pegylated liposomal doxorubicin in previously treated metastatic endometrial cancer: A Gynecologic Oncology Group study. J Clin Oncol. 2002;20(9):2360–4.

    Article  PubMed  CAS  Google Scholar 

  32. Dizon DS, Blessing JA, McMeekin S, Sharma SK, DiSilvestro P, Alvarez RD. GOG-129P phase II trial of Ixabepilone as second-line treatment in advanced endometrial cancer: Gynecologic Oncology Group trial 129P. J Clin Oncol. 2009;27(19):3104–8.

    Article  PubMed  CAS  Google Scholar 

  33. www.clinicaltrials.gov. NCT00883116. Accessed 3/30/2012.

  34. Martin-Hirsch PPL, Jarvis GG, Kitchener HC, Lilford R. Progestagens for endometrial cancer. Cochrane Database Syst Rev. 1999; Issue 3. Art. No.: CD001040. DOI: 10.1002/14651858.CD001040.

  35. Podratz KC, O’Brien PC, Malkasian GD, et al. Efffects of progestational agents in the treatment of endometrial carcinoma. Obstet Gynecol. 1985;66:106–10.

    PubMed  CAS  Google Scholar 

  36. Lentz SS, Brady MF, Major FJ, Reid GC, Sopher JT. High-dose megestrol acetate in advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group study. J Clin Oncol. 1996;14:357–61.

    PubMed  CAS  Google Scholar 

  37. Geisler HE. The use of megestrol acetate in the treatment of advanced malignant lesions of the endometrium. Gynecol Oncol. 1973;1:340–4.

    Article  Google Scholar 

  38. Thigpen T, Brady MF, Alvarez RD, et al. Oral medroxyprogesterone acetate in the treatment of advanced or recurrent endometrial carcinoma: a dose–response study by the Gynecologic Oncology Group. J Clin Oncol. 1999;17:1736–44.

    PubMed  CAS  Google Scholar 

  39. Fiorica M, Brunetto VL, Hanjani P, et al. Phase II trial of alternating course of megestrol acetate and tamoxifen in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. Gynecol Oncol. 2004;91:10–4.

    Article  Google Scholar 

  40. Thigpen T, Brady MF, Homesley HD, Soper JT, Bell J. Tamoxifen in the treatment of advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2001;19:364–7.

    PubMed  CAS  Google Scholar 

  41. Rose PG, Brunetto VL, VanLe L, Bell J, Walker JL, Lee RB. A phase II trial of anastrozole in advanced recurrent or persistent endometrial cancer: a Gynecologic Oncology Group study. Gynecol Oncol. 2000;78(2):212–6.

    Article  PubMed  CAS  Google Scholar 

  42. Asbury RF, Brunetto VL, Lee RB, Reid G, Rocereto TF. Gosereline acetate as treatment for recurrent endometrial carcinoma: a Gynecologic Oncology Group study. Am J Clin Oncol. 2002;25(6):557–60.

    Article  PubMed  Google Scholar 

  43. Oza AM, Poveda AR, Clamp S, et al. A randomized phase II trial of ridaforolimus compared with progestin or chemotherapy in female adult patients with advanced endometrial carcinoma. J Clin Oncol. 2011;29(suppl): Abstr 5009.

    Google Scholar 

  44. Kokka F, Brockbank E, Oram D, et al. Hormonal therapy in advanced or recurrent endometrial cancer (review). Cochrane Database Syst Rev. 2010;12:Art. No.: CD007926. DOI: 10.1002/14651858.CD007926.pub2.

  45. Zagouri F, Bozas G, Kafantari E, et al. Endometrial cancer: what is new in adjuvant and molecularly targeted therapy. Obstet Gynecol Int. 2010;2010:749579.

    PubMed  Google Scholar 

  46. Terakawa N, Kanamori Y, Yoshida S. Loss of PTEN expression followed by Akt phosphorylation is a poor prognostic factor for patients with endometrial cancer. Endocr Relat Cancer. 2003;10:203–8.

    Article  PubMed  CAS  Google Scholar 

  47. Kanamori Y, Kigawa J, Itamochi H, et al. Correlation between loss of PTEN expression and Akt phosphorylation in endometrial carcinoma. Clin Cancer Res. 2001;7:892–5.

    PubMed  CAS  Google Scholar 

  48. Tashiro H, Blazes MS, Wu R, et al. Mutations in PTEN are frequent in endometrial carcinoma but rare in other gynecological malignancies. Cancer Res. 1997;57(18):3935–40.

    PubMed  CAS  Google Scholar 

  49. Oda K, Stokoe D, Taketani Y, McCormick F. High frequency of coexistent mutations of PIK3CA and PTEN genes in endometrial carcinoma. Cancer Res. 2005;65:10669–73.

    Article  PubMed  CAS  Google Scholar 

  50. Oza AM, Elit L, Biagi J, et al. Molecular correlates associated with a phase II study of temsirolimus (Temsirolimus) in patients with metastatic or recurrent endometrial cancer – NCIC IND 160. Proc Am Soc Clin Oncol. 2006;24(18s):121s (abstr #3003).

    Google Scholar 

  51. Oza AM, Elit L, Tsao M, et al. Phase II study of temsirolimus in women with recurrent or metastatic endometrial cancer: a trial of the NCIC Clinical Trials Group. J Clin Oncol. 2001;29(24):3278–85.

    Article  Google Scholar 

  52. Slomovitz BM, Lu KH, Johnston T, et al. A phase 2 study of the oral mammalian target of rapamycin inhibitor, everolimus, in patients with recurrent endometrial cancer. Cancer. 2010;00:1–5.

    Google Scholar 

  53. Porta C, Calvo E, Climent MA, et al. Efficacy and safety of everolimus in elderly patients with metastatic renal cell carcinoma: an exploratory analysis of the Outcomes of elderly patients in the RECORD-1 trial. Eur Urol. 2012;61:826–33.

    Article  PubMed  CAS  Google Scholar 

  54. Aghajanian C, Sill MW, Darcy K, et al. A phase II trial of bevacizumab in recurrent or persistent endometrial cancer: a Gynecologic Oncology Group (GOG) study. J Clin Oncol. 2011;29(16):2259–65.

    Article  PubMed  CAS  Google Scholar 

  55. Biganzoli L, Di Vincenzo E, Jiang Z, et al. First line bevacizumab therapy of breast cancer: results in patients aged  >  = 70 years treated in the ATHENA study. Ann Oncol. 2012;23(1): 111–8.

    Article  PubMed  CAS  Google Scholar 

  56. Cassidy J, Saltz L, Giantonio BJ, et al. Effect of bevacizumab in older patients with metastatic colorectal cancer: pooled analysis of four randomized studies. J Cancer Res Clin Oncol. 2010;136:737–43.

    Article  PubMed  CAS  Google Scholar 

  57. Nimeiria HS, Oza AM, et al. A phase II study of sorafenib in advanced uterine carcinoma/carcinosarcoma: a trial of the Chicago, PMH, and California Phase II Consortia. Gynecol Oncol. 2010;117(1):37–40.

    Article  Google Scholar 

  58. Correa R, Mackay H, Hirte HW, et al. A phase II study of sunitinib in recurrent or metastatic endometrial carcinoma: a trial of the Princess Margaret Hospital, The University of Chicago, and California Cancer Phase II Consortia. J Clin Oncol. 2010;28(15s): ASCO#5038.

    Google Scholar 

  59. Boehm S, Rothermundt C, Hess D, Joerger M. Anti-angiogenic drugs in oncology: a focus on drug safety and the elderly – a mini-review. Gerontology. 2009;56:303–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Avenue, MC 2050, Chicago, IL, 60637, USA

    Nita Karnik Lee M.D., MPH & Gini F. Fleming M.D.

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  1. Nita Karnik Lee M.D., MPH
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  2. Gini F. Fleming M.D.
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Correspondence to Nita Karnik Lee M.D., MPH .

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Editors and Affiliations

  1. Memorial Sloan-Kettering Cancer Center, Commack Road, Commack, 11725, New York, USA

    Stuart M. Lichtman

  2. University of Liverpool, St Helens Teach, Marshalls Cross Road, St Helens, WA9 3DA, United Kingdom

    Riccardo A. Audisio

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Lee, N.K., Fleming, G.F. (2013). Treatment of Advanced Stage and Recurrent Endometrial Cancer in Elderly Women. In: Lichtman, S., Audisio, R. (eds) Management of Gynecological Cancers in Older Women. Springer, London. https://doi.org/10.1007/978-1-4471-4605-6_16

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  • DOI: https://doi.org/10.1007/978-1-4471-4605-6_16

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