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Allred score is a promising predictor of prognosis and medroxyprogesterone acetate efficacy in patients with endometrial cancer

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Abstract

Purpose

Predictors of response or disease control with oral medroxyprogesterone acetate (MPA) therapy in patients with metastatic or recurrence endometrial cancer remain to be elucidated. The purpose of this study was to clarify the effect of MPA in patients with endometrial cancer and identify markers that predict MPA efficacy.

Methods

We retrospectively analyzed clinical and pathological factors in patients who received MPA. Expression of estrogen receptor, progesterone receptor (PgR), androgen receptor, and Ki67 index was assessed with residual tissue samples of endometrial cancer. Expression levels were evaluated semi-quantitatively using the Allred score. Correlations between expression levels and patients’ characteristics, response to MPA, and survival were assessed.

Results

We analyzed clinical factors in 40 patients and molecular pathological factors in 27 patients for MPA efficacy. The overall response rate was 35% in all 40 patients and there were 10 patients (25%) with continued complete or partial response for over 5 years. However, higher Allred score for PgR (p = 0.050) tended to be and lower Ki67 labeling index (p = 0.001) were significantly predictive factors for long-term complete or partial response over 5 years. Median progression-free survival was 6.4 (2–217) months and the 5-year progression-free survival rate was 32%. Multivariate analysis showed that Allred score ≥3 for PgR (p = 0.039) was the only significant predictive marker for long-term disease control. There were no severe adverse events that resulted in discontinuation of MPA.

Conclusions

This study suggests the utility of MPA when the Allred score for PgR is ≥3. Future prospective studies are needed to confirm these findings.

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Authors and Affiliations

  1. Department of Breast and Medical Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Mayu Yunokawa, Emi Noguchi, Akihiko Shimomura, Tatsunori Shimoi, Kan Yonemori, Chikako Shimizu, Yasuhiro Fujiwara & Kenji Tamura

  2. Pathology Division, Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan

    Hiroshi Yoshida & Reiko Watanabe

Authors
  1. Mayu Yunokawa
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  2. Hiroshi Yoshida
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  3. Reiko Watanabe
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  10. Kenji Tamura
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Corresponding author

Correspondence to Mayu Yunokawa.

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Funding

This research was partially supported by a grant from the Practical Research for Innovative Cancer Control program from the Japan Agency for Medical Research and Development (AMED, No.: 15ck0106075h0002).

Conflict of interest

Dr. Tamura (research funding from Kyowa Hakko Kirin, Co.Ltd), Dr. Fujiwara (research funding from Nippon Kayaku, Co. Ltd) and Dr. Shimizu (research funding from Eli Lilly and Company, Pfizer Inc., Chugai Pharmaceutical Co. Ltd.) had conflict of interest and there are no conflicts of interest to declare for others.

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.

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Yunokawa, M., Yoshida, H., Watanabe, R. et al. Allred score is a promising predictor of prognosis and medroxyprogesterone acetate efficacy in patients with endometrial cancer. Cancer Chemother Pharmacol 80, 127–134 (2017). https://doi.org/10.1007/s00280-017-3342-5

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  • DOI: https://doi.org/10.1007/s00280-017-3342-5

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