Brian Slomovitz, MD, MS, FACOG, provides a brief review of endometrial cancer relapse and corresponding therapeutic approaches.
Brian M. Slomovitz, MD, MS, FACOG: When we talk about endometrial cancers that relapse, it’s important to note that there are different subsets, or different types of endometrial cancer. The relapse rate is based on the histological subtype. Women who have endometroid fall under the type 1 endometrial cancers, which are those that are hormonally driven. Their chance of treatment alone with a hysterectomy is 80% to 90%. Occasionally, we give adjuvant therapy, or immediate therapy after surgery, which may include radiation or chemotherapy. In total, 10% to 15% may recur from their disease and may require more systemic therapy. The more aggressive histological subtypes are primarily uterine serous cancers, carcinosarcomas, and clear-cell carcinomas. They make up a minority, about 10% of endometrial disease, but count for 50% to 60% of recurrences due to this disease. It’s much more common for those patients to require systemic therapy. It’s also important to note that the rates of endometrial cancer are rising in this country, and a lot of that is because environmental factors like obesity. Obesity drives the pathogenesis of endometrial cancer.
When we’re treating a patient with endometrial cancer over her lifetime, there are a lot of good treatment options. The first is often chemotherapy. It may take 6 months to a year for patients to have a good response and a long disease-free interval after completion of chemotherapy. If they do unfortunately recur, then 1 good treatment option would be to re-treat them with chemotherapy. If they have a disease-free interval of 6 to 12 months, treating with chemotherapy is a reasonable option if they recur again. Another option would be to continue the change to hormonal therapy, a biomarker-driven therapy, or immunotherapy, and then go back to chemotherapy at a later time.
Transcript edited for clarity.