From the Guidelines
For a 62-year-old woman with newly diagnosed primary endometrial cancer with carcinomatosis and malignant ascites, the recommended treatment typically involves systemic therapy with a combination of carboplatin and paclitaxel chemotherapy, as this regimen has shown improved survival and reduced toxicity compared to other multiagent chemotherapy regimens 1. The standard regimen includes carboplatin at an AUC (area under the curve) of 5-6 and paclitaxel 175 mg/m² administered intravenously every 3 weeks for 6 cycles. Some key points to consider in the management of this patient include:
- The use of carboplatin and paclitaxel as a first-line therapy option for advanced disease, given its favorable response rate and tolerability profile 1.
- The potential addition of bevacizumab to the carboplatin and paclitaxel regimen, which has shown promising results in terms of overall response rate and median overall survival 1.
- The management of malignant ascites, which may require therapeutic paracentesis for symptom relief.
- The consideration of hormonal therapy with progestins, such as megestrol acetate or medroxyprogesterone, for lower-grade tumors with hormone receptor positivity.
- The potential role of surgical cytoreduction, although this is often limited in cases with carcinomatosis.
- The use of radiation therapy for palliative purposes, targeting specific symptomatic areas. It is essential to note that the presence of carcinomatosis and malignant ascites indicates advanced disease with a challenging prognosis, and the primary goal of treatment is to control disease spread, manage symptoms, and improve quality of life 1.
From the FDA Drug Label
Adjunctive therapy and palliative treatment of inoperable, recurrent, and metastatic endometrial or renal carcinoma. The treatment option for a 62-year-old woman newly diagnosed with primary endometrial cancer with carcinomatosis and malignant ascites is adjunctive therapy and palliative treatment with medroxyprogesterone acetate (PO) 2.
- Key points:
- Medroxyprogesterone acetate (PO) is used for inoperable, recurrent, and metastatic endometrial carcinoma.
- The patient's condition, carcinomatosis and malignant ascites, suggests metastatic disease, which is an indication for medroxyprogesterone acetate (PO) treatment.
From the Research
Treatment Options for Advanced Endometrial Cancer
The treatment options for a 62-year-old woman newly diagnosed with primary endometrial cancer with carcinomatosis and malignant ascites include:
- Chemotherapy regimens such as carboplatin and nonpegylated liposomal doxorubicin 3
- Combination therapy with paclitaxel, carboplatin, and bevacizumab 4
- Immunotherapy with pembrolizumab and lenvatinib for women who are not microsatellite instability high (MSI-H) or are mismatch repair proficient (MMR-proficient) 5
- Treatment with immune checkpoint inhibitors, which is transitioning from second-line to first-line therapy 6
Chemotherapy Regimens
Chemotherapy regimens for advanced endometrial cancer include:
- Carboplatin and nonpegylated liposomal doxorubicin, which has shown considerable activity and should be evaluated further 3
- Paclitaxel and carboplatin, which is a standard chemotherapy regimen for endometrial cancer 4, 6
- Doxorubicin and cisplatin, which is also a standard chemotherapy regimen for endometrial cancer 6
Immunotherapy
Immunotherapy options for advanced endometrial cancer include:
- Pembrolizumab and lenvatinib combination therapy, which has shown benefits in clinical trials 5, 6
- Dostarlimab, durvalumab, and atezolizumab, which have shown better results in clinical trials but are not yet approved in some countries 6
Current Status and Recent Advancements
The current status and recent advancements in therapeutic options for patients with advanced and recurrent endometrial cancer have expanded since The Cancer Genome Atlas (TCGA) identified 4 distinct endometrial cancer subgroups associated with differential survival 7 The NCCN Guidelines for Uterine Neoplasms provide detailed recommendations regarding the diagnosis, workup, and management of endometrial cancer 7