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Progestogens in Endometrial Cancer

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Progestogens in Obstetrics and Gynecology

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Abstract

The gold standard therapeutic approach for Endometrial Cancer (EC) includes surgery with total hysterectomy, bilateral salpingo-oophorectomy with or without lymph node assessment. However, patients who carry a high surgical risk or patients who desire fertility preservation, can benefit from conservative treatment options using progestogens Prior to choosing this approach, proper risk assessment is required to exclude the presence of deep myometrial invasion, extra-uterine disease, or a synchronous ovarian cancer. Work-up includes endometrial biopsy, imaging to assess myometrial invasion and adnexal involvement, and genetic counseling.

Conservative treatment of EC with progestins has been described over 50 years ago, and several types of medications have been used, mainly medroxyprogesterone acetate and megesterol acetate, showing similar outcomes. However, progestin treatment is not without side effects, including increased risk of thrombosis and weight gain. The use of the levonorgestrel intrauterine device (LNG-IUD) has increased in recent years and has a lower rate of systemic adverse effects. There is no consensus regarding the optimal progestin duration, though current guidelines recommend treatment for a minimum of 6 months. Obesity and presence of progesterone receptor have been associated with response to treatment.

Although data is mostly limited to retrospective studies, several meta-analyses have shown a complete response rate between 48.2% and 76%, although high rate of relapses (around 30–40%) are observed. In terms of fertility, pregnancy is achievable in patients who had complete response, with live birth rates of up to 25%. Hysterectomy remains recommended once family planning is completed, but re-treatment with progestins has been described, leading however to lower response rates and lower pregnancy rates.

When compared to oral progestin, treatment with LNG-IUD has been shown to have similar, or even slightly improved outcome, and combined treatment of LNG-IUD and oral progestins is currently being evaluated. The combination of hysteroscopic resection of tumor together with progestin treatment has been suggested to be superior to progestins alone, both in terms of regression rate and live birth rate.

In patients with more advanced endometrial cancer, progestogen treatment is not as effective, with response rates of 11–16%, however it may be beneficial in frail patients who cannot tolerate surgery or chemotherapy.

Large prospective studies are currently underway to try and further study the role of progestins in fertility spearing treatment of endometrial cancer.

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Authors and Affiliations

  1. McGill University-Jewish General Hospital, Montreal, QC, Canada

    Oded Raban & Walter Gotlieb

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  1. Oded Raban
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  2. Walter Gotlieb
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Correspondence to Walter Gotlieb .

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  1. Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Howard J.A. Carp

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Raban, O., Gotlieb, W. (2021). Progestogens in Endometrial Cancer. In: Carp, H.J. (eds) Progestogens in Obstetrics and Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-030-52508-8_11

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