Systemic Treatment of Advanced Endometrial Carcinoma

Abstract

Endometrial cancer has shown a rising trend over the past 30 years. The incidence has gone up by 21 % since 2008, and the death rate has increased by more than 100 % over the past two decades [1]. Although there is strong data correlating hyperestrogenism and low-grade endometrial cancers, recently link with higher-grade/stage tumors also has been reported [2]. As the median age of endometrial cancer is 63 years, aging population with an increase in average life span also contributes to rise in incidence. In early-stage disease which comprises almost 85 % of case, advancements in surgical techniques as well as staging, focused/limited radiation, and incorporation of structured chemotherapy have dramatically improved outcomes. In developed countries, stage 3 comprises 12 % and stage 4 less than 5 % of endometrial cancers [4]. Depending on the histology, there is wide variation in response to systemic treatment. Systemic management encompasses chemotherapy, hormone manipulation, and molecularly targeted agents. In high-grade tumors with a rapid growth pattern and visceral metastases, chemotherapy is preferred. With the advent of molecular profiling, cancer signaling pathway mutations in endometrial carcinoma have been understood. Various agents to target these have been developed, and many are still in clinical trials.