Chemo May Not Improve Recurrent Endometrial Cancer Outcomes

Adding chemotherapy did not improve outcomes for patients with endometrial cancer that recurred in the pelvic region.

Radiation alone was found to be effective in treating local endometrial cancer recurrences, indicating that patients may be able to skip chemotherapy — and the side effects that go along with it — in this setting.

A recent study published in the Journal of Clinical Oncology analyzed data from 165 patients with recurrent endometrial cancer. Half of the patients were randomly assigned to receive radiation alone, while the other half were assigned to receive radiation plus the chemotherapy drug, cisplatin.

Findings showed that there was no statistically significant difference between the two groups, meaning that the researchers could not definitively say that one was superior, when it came to progression-free survival (PFS). PFS is the time patients live without their disease worsening, according to the National Cancer Institute. Median PFS was not reached for the radiation group and was 73 months for the chemotherapy plus radiation group.

“We were a little surprised because in other diseases, [the addition of chemotherapy] has been helpful. But in this setting, it did not seem to add to increasing the probability of people being free of progression,” study author, Dr. Ann H. Klopp said in an interview with CURE®.

Klopp is a professor of radiation oncology at The University of Texas MD Anderson Cancer Center in Houston.

Further, at three years after treatment, 73% of patients in the radiation group were still alive and without disease progression, compared to 62% in the chemotherapy-containing group. Klopp mentioned that there was also no difference in overall survival (time patients live before death of any cause) between the two groups.

“It’s useful information to know that radiation alone for these patients who were eligible for the study was the most effective treatment and had the least toxicity,” Klopp said.

Common side effects from cisplatin, Klopp explained, include nausea, low white or red blood cells and potential kidney injury. The drug has also been linked to neurologic symptoms, such as peripheral neuropathy, which presents as pain and/or tingling in the hands and feet. “That’s all avoided by not having chemotherapy,” Klopp said.

READ MORE: Chemotherapy-Induced Peripheral Neuropathy: The Invisible Side Effect

However, when interpreting these results, Klopp mentioned that it is important to highlight the patient population in the study.

“I think one important thing to consider is the patients who were enrolled in the trial were not necessarily all patients with locally recurrent endometrial cancer. They tended to be patients with low risk of recurrence,” Klopp said. “So it’s still a valuable conversation to have with the treating oncologist about whether chemotherapy could still make sense for each individual.”

All patients enrolled in the study had endometrial cancer that was treated and then came back (recurred) in the pelvic area. For the majority of the study population (86%), the recurrences were confined to the vagina. The tumors were smaller (approximately 1 to 2 centimeters) compared to higher risk tumors, which could be 4 centimeters or larger. The cancer histology — which are features examined under a microscope — indicated that the disease was less likely to be aggressive.

Looking ahead, there is still more work to be done for this patient population, and in the endometrial cancer space at large, according to Klopp.

“Less chemotherapy for these patients [can be beneficial] and I think the next steps are figuring out how we can still do better, because 73% [PFS] is high, but not as high as we would want it to be,” Klopp said. “So we can look further into improving radiation, either with the ways we do it or through adding additional agents like immunotherapy, for example.”

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