From the Guidelines
The recommended treatment for metastasized uterine cancer is a multimodal approach combining systemic therapy with surgery and/or radiation when appropriate, with first-line treatment often including platinum-based chemotherapy regimens such as carboplatin and paclitaxel, or hormonal therapies like megestrol acetate, tamoxifen, or aromatase inhibitors for hormone receptor-positive tumors, as supported by the most recent guidelines 1.
Treatment Approach
The treatment of metastasized uterine cancer should be individualized based on the patient's histologic subtype, molecular profile, previous treatments, performance status, and disease burden.
- For patients with endometrioid histologies, hormonal therapy is typically used for lower-grade tumors, preferably in patients with small tumor volume or an indolent growth pace.
- Hormonal agents for treating recurrent/metastatic disease include megestrol acetate with alternating tamoxifen, medroxyprogesterone acetate/tamoxifen (alternating), everolimus/letrozole combination, progestational agents, aromatase inhibitors, tamoxifen alone, or fulvestrant.
- The main predictors of response in the treatment of metastatic disease are well-differentiated tumors, expression of ER/PR receptors, a long disease-free interval, and the location and extent of extrapelvic (particularly pulmonary) metastases.
Chemotherapy and Targeted Therapies
- Platinum-based chemotherapy regimens such as carboplatin and paclitaxel are commonly used for first-line treatment.
- Targeted therapies, including pembrolizumab for mismatch repair deficient tumors and lenvatinib plus pembrolizumab for advanced disease regardless of biomarker status, have emerged as important options.
- Everolimus combined with letrozole is recommended for recurrent disease of endometrioid histology, with a clinical benefit rate and objective response rate of 40% and 32%, respectively, in a phase II trial 1.
Palliative Care and Monitoring
- Palliative care should be integrated early to manage symptoms and improve quality of life.
- Treatment response should be monitored with imaging every 2-3 cycles of therapy, and regimens adjusted based on response and tolerability.
- The approach targets cancer cells through different mechanisms, including chemotherapy disrupting cell division, hormonal therapies blocking growth signals, and immunotherapies enhancing the body's ability to recognize and attack cancer cells.
From the Research
Treatment Options for Metastasized Uterine Cancer
- The recommended treatment for a patient with metastasized uterine cancer may involve chemotherapy, with paclitaxel and carboplatin being a commonly used combination 2, 3, 4, 5.
- This combination has shown promising results in terms of response rate and overall survival, with a response rate of 62% reported in one study 2 and 54% in another 3.
- The treatment is generally well-tolerated, with expected hematologic toxicity and minimal non-hematologic grade 4 toxicity 3.
- Other treatment options, such as hormonal therapy and molecularly targeted therapies, may also be considered, depending on the specific type and stage of the cancer 6.
Chemotherapy Regimens
- Paclitaxel and carboplatin can be administered every 3 weeks, with a total of 6 cycles planned 4, 5.
- The dosage of paclitaxel is typically 175 mg/m2, and carboplatin is administered at an area under the serum concentration-time curve of 5-6 4, 5.
- Dose reduction, treatment delay, or treatment cessation may be necessary in some cases due to toxicity 5.
Efficacy and Survival
- The combination of paclitaxel and carboplatin has been shown to improve progression-free survival and overall survival in patients with metastasized uterine cancer 4, 5.
- Median progression-free survival and overall survival rates have been reported to be around 9-15 months and 21-27 months, respectively 2, 5.
- However, the efficacy of the treatment may vary depending on the specific type and stage of the cancer, as well as the patient's overall health and response to treatment 6.