RT Book, Section
A1 Onstad, Michaela A.
A1 Westin, Shannon N.
A1 Lu, Karen H.
A2 Kantarjian, Hagop M.
A2 Wolff, Robert A.
A2 Rieber, Alyssa G.
SR Print(0)
ID 1190837099
T1 Tumors of the Uterine Corpus
T2 The MD Anderson Manual of Medical Oncology, 4e
YR 2022
FD 2022
PB McGraw Hill Education
PP New York, NY
SN 9781260467642
LK hemonc.mhmedical.com/content.aspx?aid=1190837099
RD 2023/12/08
AB KEY  CONCEPTSFor  women  with  early-stage,  intermediate-risk  endometrial  cancer,  there  is  no  evidence  that  adjuvant  therapy  improves  overall  survival.  For  women  with  low-intermediate-risk  disease,  observation  is  favored.  For  women  with  high-intermediate-risk  disease,  vaginal  cuff  brachytherapy  is  favored.Women  with  high-risk  disease  have  either  serous  or  clear  cell  adenocarcinoma  (any  stage)  or  have  pathologic  stage  III  disease  with  extrauterine  involvement.  Adjuvant  treatment  may  involve  radiation,  chemotherapy,  or  a  combination  of  the  two  modalities,  based  on  histology,  stage,  and  other  factorsRecurrent  or  metastatic  endometrial  cancer  is  associated  with  a  poor  prognosis.  Clinical  trial  GOG  209  supports  the  use  of  carboplatin  and  paclitaxel  in  this  setting.Immunotherapy  may  be  considered  as  second-line  treatment  for  recurrent/metastatic  endometrial  cancer.  Pembrolizumab  has  a  response  rate  (RR)  of  53%  for  women  with  mismatch  repair–deficient  tumors.  The  combination  of  pembrolizumab  with  the  tyrosine  kinase  inhibitor  lenvatinib  has  a  RR  of  38%  among  women  with  microsatellite  stable  tumors.Targeted  therapies  with  demonstrated  efficacy  in  second-line  treatment  include  single-agent  bevacizumab  (GOG229E),  and  the  combination  of  the  mTOR  inhibitor  everolimus  with  letrozole.Endocrine  therapy  may  also  be  used  to  treat  metastatic/recurrent  endometrial  cancer.  It  tends  to  be  well  tolerated  with  relatively  minor  side  effects,  and  has  modest  RRs,  ranging  from  11%  to  24%.  Characteristics  that  improve  the  likelihood  that  a  patient  will  have  a  favorable  response  to  hormone  therapy  include  having  a  low  tumor  grade  (1  or  2),  endometrioid  histology,  the  presence  of  estrogen  and  progesterone  receptors,  having  a  longer  disease-free  interval,  and  being  asymptomatic  or  minimally  symptomatic.