Advertisement

Neoadjuvant chemotherapy in patients with advanced endometrial cancer

  • Olivia R. Khouri
  • Melissa K. Frey
  • Fernanda Musa
  • Franco Muggia
  • Jessica Lee
  • Leslie Boyd
  • John P. Curtin
  • Bhavana PothuriEmail author
Original Article
  • 26 Downloads

Abstract

Objectives

Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is a treatment strategy for ovarian cancer patients with unresectable disease or poor performance status (PS). This strategy has been used in the treatment of advanced endometrial cancer and a survival benefit has been shown in patients who are subsequently able to undergo interval cytoreduction. This study sought to review our single institution experience with NACT for advanced endometrial cancer.

Methods

We conducted a retrospective review of all patients who received NACT for advanced endometrial cancer at two institutions in New York City between 2002 and 2016.

Results

We identified 39 patients (median age 61, range 35–89). The histologic subtype distribution was: serous (44%), endometrioid (28%), carcinosarcoma (10%), clear cell (8%), mixed (8%), neuroendocrine (3%). Contraindications to primary surgery included: unresectable disease (72%), poor PS (15%), unresectable disease and poor PS (13%). Twenty-three patients (59%) did not undergo IDS due to: progression of disease (70%), medical ineligibility (4%), unresectable disease (17%), lost to follow-up (4%), death (4%). Sixteen patients (41%) underwent IDS, 81% had an optimal cytoreduction. Disease status at NACT completion was: partial response (56%), stable disease (3%) and progression of disease (41%). There were no complete responses. Patients who responded to NACT had a significantly longer overall survival than those who did not (15 vs. 5 months. P = 0.015). IDS was also associated with an improvement in overall survival versus no surgery (16 vs. 6 months, P = 0.04).

Conclusions

Unlike ovarian cancer, less than half of the patients undergoing NACT for endometrial cancer underwent IDS, none had a complete response, and 41% had disease progression during NACT. However, endometrial cancer patients who underwent IDS had a high rate of optimal cytoreduction. Both response to NACT and IDS were associated with improved survival.

Keywords

Endometrial cancer Neoadjuvant chemotherapy Interval debulking 

Notes

Compliance with ethical standards

Conflict of interest

No funding was received for the execution of this work. None of the authors have any conflict of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study (retrospective chart review), formal consent is not required.

References

  1. 1.
    Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Kosary CL, Yu M, Ruhl J,Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds) SEER Cancer Statistics Review, 1975–2014. National Cancer Institute. Bethesda, MD. https://seer.cancer.gov/csr/1975_2014/, based on November 2016 SEER data submission, posted to the SEER web site, April 2017
  2. 2.
    Vergote I, De Wever I, Tjalma W, Van Gramberen M, Decloedt J, Van Dam P (1998) Neoadjuvant chemotherapy or primary debulking surgery in advanced ovarian carcinoma: a retrospective analysis of 285 patients. Gynecol Oncol 71:431–436CrossRefGoogle Scholar
  3. 3.
    Chambers JT, Chambers SK, Voynick IM, Schwartz PE (1990) Neoadjuvant chemotherapy in stage X ovarian carcinoma. Gynecol Oncol 37:327–331CrossRefGoogle Scholar
  4. 4.
    Wright AA et al (2016) Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline. Gynecol Oncol 143(1):3–15CrossRefGoogle Scholar
  5. 5.
    Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I (2005) Endometrial cancer. Lancet 366:591–605CrossRefGoogle Scholar
  6. 6.
    Homesley HD, Filiaci V, Gibbons SK et al (2009) 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 112(3):543–552CrossRefGoogle Scholar
  7. 7.
    Vandenput I, Van Calster B, Capoen A et al (2009) Neoadjuvant chemotherapy followed by interval debulking surgery in patients with serous endometrial cancer with transperitoneal spread (stage IV): a new preferred treatment? Br J Cancer 101(2):244–249CrossRefGoogle Scholar
  8. 8.
    Eisenhauer E, Verweji J (2009) Response assessment in solid tumours (RECIST): version 1. 1 and supporting papers. Eur J Cancer 45(2):225–310CrossRefGoogle Scholar
  9. 9.
    Kehoe S, Hook J, Nankivell M, Jayson GC, Kitchener H, Lopes T, Luesley D, Perren T, Bannoo S, Mascarenhas M, Dobbs S, Essapen S, Twigg J, Herod J, McCluggage G, Parmar M, Swart AM (2015) Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet.  https://doi.org/10.1016/s0140-6736(14)62223-6 Google Scholar
  10. 10.
    Simpkins F, Drake R, Escobar PF, Nutter B, Rasool N, Rose PG (2015) A phase II trial of paclitaxel, carboplatin, and bevacizumab in advanced and recurrent endometrial carcinoma (EMCA). Gynecol Oncol 136(2):240–245.  https://doi.org/10.1016/j.ygyno.2014.12.004 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Olivia R. Khouri
    • 1
  • Melissa K. Frey
    • 2
  • Fernanda Musa
    • 3
  • Franco Muggia
    • 1
  • Jessica Lee
    • 4
  • Leslie Boyd
    • 1
  • John P. Curtin
    • 1
  • Bhavana Pothuri
    • 1
    Email author
  1. 1.New York University, School of MedicineNew YorkUSA
  2. 2.New York Presbyterian – Weill Cornell Medical CollegeNew YorkUSA
  3. 3.Pacific Gynecology Specialists, Swedish Cancer InstituteSeattleUSA
  4. 4.University of Texas, SouthwesternDallasUSA

Personalised recommendations