Neoadjuvant chemotherapy in patients with advanced endometrial cancer
Objectives Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is a treatment strategy for ovarian cancer patients with unresectable disease or poor performance status (PS). This strategy has been used in the treatment of advanced endometrial cancer and a survival benefit ha...
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| Published in: | Cancer chemotherapy and pharmacology Vol. 84; no. 2; pp. 281 - 285 |
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| Main Authors: | , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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Berlin/Heidelberg
Springer Berlin Heidelberg
01.08.2019
Springer Nature B.V |
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| ISSN: | 0344-5704, 1432-0843, 1432-0843 |
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| Abstract | Objectives
Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is a treatment strategy for ovarian cancer patients with unresectable disease or poor performance status (PS). This strategy has been used in the treatment of advanced endometrial cancer and a survival benefit has been shown in patients who are subsequently able to undergo interval cytoreduction. This study sought to review our single institution experience with NACT for advanced endometrial cancer.
Methods
We conducted a retrospective review of all patients who received NACT for advanced endometrial cancer at two institutions in New York City between 2002 and 2016.
Results
We identified 39 patients (median age 61, range 35–89). The histologic subtype distribution was: serous (44%), endometrioid (28%), carcinosarcoma (10%), clear cell (8%), mixed (8%), neuroendocrine (3%). Contraindications to primary surgery included: unresectable disease (72%), poor PS (15%), unresectable disease and poor PS (13%). Twenty-three patients (59%) did not undergo IDS due to: progression of disease (70%), medical ineligibility (4%), unresectable disease (17%), lost to follow-up (4%), death (4%). Sixteen patients (41%) underwent IDS, 81% had an optimal cytoreduction. Disease status at NACT completion was: partial response (56%), stable disease (3%) and progression of disease (41%). There were no complete responses. Patients who responded to NACT had a significantly longer overall survival than those who did not (15 vs. 5 months.
P
= 0.015). IDS was also associated with an improvement in overall survival versus no surgery (16 vs. 6 months,
P
= 0.04).
Conclusions
Unlike ovarian cancer, less than half of the patients undergoing NACT for endometrial cancer underwent IDS, none had a complete response, and 41% had disease progression during NACT. However, endometrial cancer patients who underwent IDS had a high rate of optimal cytoreduction. Both response to NACT and IDS were associated with improved survival. |
|---|---|
| AbstractList | Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is a treatment strategy for ovarian cancer patients with unresectable disease or poor performance status (PS). This strategy has been used in the treatment of advanced endometrial cancer and a survival benefit has been shown in patients who are subsequently able to undergo interval cytoreduction. This study sought to review our single institution experience with NACT for advanced endometrial cancer.OBJECTIVESNeoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is a treatment strategy for ovarian cancer patients with unresectable disease or poor performance status (PS). This strategy has been used in the treatment of advanced endometrial cancer and a survival benefit has been shown in patients who are subsequently able to undergo interval cytoreduction. This study sought to review our single institution experience with NACT for advanced endometrial cancer.We conducted a retrospective review of all patients who received NACT for advanced endometrial cancer at two institutions in New York City between 2002 and 2016.METHODSWe conducted a retrospective review of all patients who received NACT for advanced endometrial cancer at two institutions in New York City between 2002 and 2016.We identified 39 patients (median age 61, range 35-89). The histologic subtype distribution was: serous (44%), endometrioid (28%), carcinosarcoma (10%), clear cell (8%), mixed (8%), neuroendocrine (3%). Contraindications to primary surgery included: unresectable disease (72%), poor PS (15%), unresectable disease and poor PS (13%). Twenty-three patients (59%) did not undergo IDS due to: progression of disease (70%), medical ineligibility (4%), unresectable disease (17%), lost to follow-up (4%), death (4%). Sixteen patients (41%) underwent IDS, 81% had an optimal cytoreduction. Disease status at NACT completion was: partial response (56%), stable disease (3%) and progression of disease (41%). There were no complete responses. Patients who responded to NACT had a significantly longer overall survival than those who did not (15 vs. 5 months. P = 0.015). IDS was also associated with an improvement in overall survival versus no surgery (16 vs. 6 months, P = 0.04).RESULTSWe identified 39 patients (median age 61, range 35-89). The histologic subtype distribution was: serous (44%), endometrioid (28%), carcinosarcoma (10%), clear cell (8%), mixed (8%), neuroendocrine (3%). Contraindications to primary surgery included: unresectable disease (72%), poor PS (15%), unresectable disease and poor PS (13%). Twenty-three patients (59%) did not undergo IDS due to: progression of disease (70%), medical ineligibility (4%), unresectable disease (17%), lost to follow-up (4%), death (4%). Sixteen patients (41%) underwent IDS, 81% had an optimal cytoreduction. Disease status at NACT completion was: partial response (56%), stable disease (3%) and progression of disease (41%). There were no complete responses. Patients who responded to NACT had a significantly longer overall survival than those who did not (15 vs. 5 months. P = 0.015). IDS was also associated with an improvement in overall survival versus no surgery (16 vs. 6 months, P = 0.04).Unlike ovarian cancer, less than half of the patients undergoing NACT for endometrial cancer underwent IDS, none had a complete response, and 41% had disease progression during NACT. However, endometrial cancer patients who underwent IDS had a high rate of optimal cytoreduction. Both response to NACT and IDS were associated with improved survival.CONCLUSIONSUnlike ovarian cancer, less than half of the patients undergoing NACT for endometrial cancer underwent IDS, none had a complete response, and 41% had disease progression during NACT. However, endometrial cancer patients who underwent IDS had a high rate of optimal cytoreduction. Both response to NACT and IDS were associated with improved survival. Objectives Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is a treatment strategy for ovarian cancer patients with unresectable disease or poor performance status (PS). This strategy has been used in the treatment of advanced endometrial cancer and a survival benefit has been shown in patients who are subsequently able to undergo interval cytoreduction. This study sought to review our single institution experience with NACT for advanced endometrial cancer. Methods We conducted a retrospective review of all patients who received NACT for advanced endometrial cancer at two institutions in New York City between 2002 and 2016. Results We identified 39 patients (median age 61, range 35–89). The histologic subtype distribution was: serous (44%), endometrioid (28%), carcinosarcoma (10%), clear cell (8%), mixed (8%), neuroendocrine (3%). Contraindications to primary surgery included: unresectable disease (72%), poor PS (15%), unresectable disease and poor PS (13%). Twenty-three patients (59%) did not undergo IDS due to: progression of disease (70%), medical ineligibility (4%), unresectable disease (17%), lost to follow-up (4%), death (4%). Sixteen patients (41%) underwent IDS, 81% had an optimal cytoreduction. Disease status at NACT completion was: partial response (56%), stable disease (3%) and progression of disease (41%). There were no complete responses. Patients who responded to NACT had a significantly longer overall survival than those who did not (15 vs. 5 months. P = 0.015). IDS was also associated with an improvement in overall survival versus no surgery (16 vs. 6 months, P = 0.04). Conclusions Unlike ovarian cancer, less than half of the patients undergoing NACT for endometrial cancer underwent IDS, none had a complete response, and 41% had disease progression during NACT. However, endometrial cancer patients who underwent IDS had a high rate of optimal cytoreduction. Both response to NACT and IDS were associated with improved survival. ObjectivesNeoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is a treatment strategy for ovarian cancer patients with unresectable disease or poor performance status (PS). This strategy has been used in the treatment of advanced endometrial cancer and a survival benefit has been shown in patients who are subsequently able to undergo interval cytoreduction. This study sought to review our single institution experience with NACT for advanced endometrial cancer.MethodsWe conducted a retrospective review of all patients who received NACT for advanced endometrial cancer at two institutions in New York City between 2002 and 2016.ResultsWe identified 39 patients (median age 61, range 35–89). The histologic subtype distribution was: serous (44%), endometrioid (28%), carcinosarcoma (10%), clear cell (8%), mixed (8%), neuroendocrine (3%). Contraindications to primary surgery included: unresectable disease (72%), poor PS (15%), unresectable disease and poor PS (13%). Twenty-three patients (59%) did not undergo IDS due to: progression of disease (70%), medical ineligibility (4%), unresectable disease (17%), lost to follow-up (4%), death (4%). Sixteen patients (41%) underwent IDS, 81% had an optimal cytoreduction. Disease status at NACT completion was: partial response (56%), stable disease (3%) and progression of disease (41%). There were no complete responses. Patients who responded to NACT had a significantly longer overall survival than those who did not (15 vs. 5 months. P = 0.015). IDS was also associated with an improvement in overall survival versus no surgery (16 vs. 6 months, P = 0.04).ConclusionsUnlike ovarian cancer, less than half of the patients undergoing NACT for endometrial cancer underwent IDS, none had a complete response, and 41% had disease progression during NACT. However, endometrial cancer patients who underwent IDS had a high rate of optimal cytoreduction. Both response to NACT and IDS were associated with improved survival. Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is a treatment strategy for ovarian cancer patients with unresectable disease or poor performance status (PS). This strategy has been used in the treatment of advanced endometrial cancer and a survival benefit has been shown in patients who are subsequently able to undergo interval cytoreduction. This study sought to review our single institution experience with NACT for advanced endometrial cancer. We conducted a retrospective review of all patients who received NACT for advanced endometrial cancer at two institutions in New York City between 2002 and 2016. We identified 39 patients (median age 61, range 35-89). The histologic subtype distribution was: serous (44%), endometrioid (28%), carcinosarcoma (10%), clear cell (8%), mixed (8%), neuroendocrine (3%). Contraindications to primary surgery included: unresectable disease (72%), poor PS (15%), unresectable disease and poor PS (13%). Twenty-three patients (59%) did not undergo IDS due to: progression of disease (70%), medical ineligibility (4%), unresectable disease (17%), lost to follow-up (4%), death (4%). Sixteen patients (41%) underwent IDS, 81% had an optimal cytoreduction. Disease status at NACT completion was: partial response (56%), stable disease (3%) and progression of disease (41%). There were no complete responses. Patients who responded to NACT had a significantly longer overall survival than those who did not (15 vs. 5 months. P = 0.015). IDS was also associated with an improvement in overall survival versus no surgery (16 vs. 6 months, P = 0.04). Unlike ovarian cancer, less than half of the patients undergoing NACT for endometrial cancer underwent IDS, none had a complete response, and 41% had disease progression during NACT. However, endometrial cancer patients who underwent IDS had a high rate of optimal cytoreduction. Both response to NACT and IDS were associated with improved survival. |
| Author | Boyd, Leslie Lee, Jessica Khouri, Olivia R. Musa, Fernanda Frey, Melissa K. Muggia, Franco Curtin, John P. Pothuri, Bhavana |
| Author_xml | – sequence: 1 givenname: Olivia R. surname: Khouri fullname: Khouri, Olivia R. organization: New York University, School of Medicine – sequence: 2 givenname: Melissa K. surname: Frey fullname: Frey, Melissa K. organization: New York Presbyterian – Weill Cornell Medical College – sequence: 3 givenname: Fernanda surname: Musa fullname: Musa, Fernanda organization: Pacific Gynecology Specialists, Swedish Cancer Institute – sequence: 4 givenname: Franco surname: Muggia fullname: Muggia, Franco organization: New York University, School of Medicine – sequence: 5 givenname: Jessica surname: Lee fullname: Lee, Jessica organization: University of Texas, Southwestern – sequence: 6 givenname: Leslie surname: Boyd fullname: Boyd, Leslie organization: New York University, School of Medicine – sequence: 7 givenname: John P. surname: Curtin fullname: Curtin, John P. organization: New York University, School of Medicine – sequence: 8 givenname: Bhavana surname: Pothuri fullname: Pothuri, Bhavana email: bhavana.pothuri@nyumc.org organization: New York University, School of Medicine |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30980132$$D View this record in MEDLINE/PubMed |
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| References | VergoteIDe WeverITjalmaWVan GramberenMDecloedtJVan DamPNeoadjuvant chemotherapy or primary debulking surgery in advanced ovarian carcinoma: a retrospective analysis of 285 patientsGynecol Oncol19987143143610.1006/gyno.1998.52131:STN:280:DyaK1M7gs1SqtQ%3D%3D9887245 AmantFMoermanPNevenPTimmermanDVan LimbergenEVergoteIEndometrial cancerLancet200536659160510.1016/S0140-6736(05)67063-8 SimpkinsFDrakeREscobarPFNutterBRasoolNRosePGA phase II trial of paclitaxel, carboplatin, and bevacizumab in advanced and recurrent endometrial carcinoma (EMCA)Gynecol Oncol2015136224024510.1016/j.ygyno.2014.12.0041:CAS:528:DC%2BC2MXis1eku78%3D25485782 ChambersJTChambersSKVoynickIMSchwartzPENeoadjuvant chemotherapy in stage X ovarian carcinomaGynecol Oncol19903732733110.1016/0090-8258(90)90361-N1:STN:280:DyaK3c3ns12iug%3D%3D2351315 VandenputIVan CalsterBCapoenANeoadjuvant chemotherapy followed by interval debulking surgery in patients with serous endometrial cancer with transperitoneal spread (stage IV): a new preferred treatment?Br J Cancer2009101224424910.1038/sj.bjc.66051571:CAS:528:DC%2BD1MXoslOmu78%3D195682452720217 HomesleyHDFiliaciVGibbonsSKA randomized phase III trial in advanced endometrial carcinoma of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: a Gynecologic Oncology Group StudyGynecol Oncol2009112354355210.1016/j.ygyno.2008.11.0141:CAS:528:DC%2BD1MXisVOiu7s%3D19108877 WrightAANeoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice GuidelineGynecol Oncol2016143131510.1016/j.ygyno.2016.05.022276506845413203 Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Kosary CL, Yu M, Ruhl J,Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds) SEER Cancer Statistics Review, 1975–2014. National Cancer Institute. Bethesda, MD. https://seer.cancer.gov/csr/1975_2014/, based on November 2016 SEER data submission, posted to the SEER web site, April 2017 KehoeSHookJNankivellMJaysonGCKitchenerHLopesTLuesleyDPerrenTBannooSMascarenhasMDobbsSEssapenSTwiggJHerodJMcCluggageGParmarMSwartAMPrimary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trialLancet201510.1016/s0140-6736(14)62223-626638963 EisenhauerEVerwejiJResponse assessment in solid tumours (RECIST): version 1. 1 and supporting papersEur J Cancer200945222531010.1016/j.ejca.2008.10.02619068275 AA Wright (3838_CR4) 2016; 143 S Kehoe (3838_CR9) 2015 F Simpkins (3838_CR10) 2015; 136 F Amant (3838_CR5) 2005; 366 E Eisenhauer (3838_CR8) 2009; 45 I Vandenput (3838_CR7) 2009; 101 JT Chambers (3838_CR3) 1990; 37 3838_CR1 HD Homesley (3838_CR6) 2009; 112 I Vergote (3838_CR2) 1998; 71 |
| References_xml | – reference: Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Kosary CL, Yu M, Ruhl J,Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds) SEER Cancer Statistics Review, 1975–2014. National Cancer Institute. Bethesda, MD. https://seer.cancer.gov/csr/1975_2014/, based on November 2016 SEER data submission, posted to the SEER web site, April 2017 – reference: ChambersJTChambersSKVoynickIMSchwartzPENeoadjuvant chemotherapy in stage X ovarian carcinomaGynecol Oncol19903732733110.1016/0090-8258(90)90361-N1:STN:280:DyaK3c3ns12iug%3D%3D2351315 – reference: EisenhauerEVerwejiJResponse assessment in solid tumours (RECIST): version 1. 1 and supporting papersEur J Cancer200945222531010.1016/j.ejca.2008.10.02619068275 – reference: SimpkinsFDrakeREscobarPFNutterBRasoolNRosePGA phase II trial of paclitaxel, carboplatin, and bevacizumab in advanced and recurrent endometrial carcinoma (EMCA)Gynecol Oncol2015136224024510.1016/j.ygyno.2014.12.0041:CAS:528:DC%2BC2MXis1eku78%3D25485782 – reference: AmantFMoermanPNevenPTimmermanDVan LimbergenEVergoteIEndometrial cancerLancet200536659160510.1016/S0140-6736(05)67063-8 – reference: VandenputIVan CalsterBCapoenANeoadjuvant chemotherapy followed by interval debulking surgery in patients with serous endometrial cancer with transperitoneal spread (stage IV): a new preferred treatment?Br J Cancer2009101224424910.1038/sj.bjc.66051571:CAS:528:DC%2BD1MXoslOmu78%3D195682452720217 – reference: VergoteIDe WeverITjalmaWVan GramberenMDecloedtJVan DamPNeoadjuvant chemotherapy or primary debulking surgery in advanced ovarian carcinoma: a retrospective analysis of 285 patientsGynecol Oncol19987143143610.1006/gyno.1998.52131:STN:280:DyaK1M7gs1SqtQ%3D%3D9887245 – reference: HomesleyHDFiliaciVGibbonsSKA randomized phase III trial in advanced endometrial carcinoma of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: a Gynecologic Oncology Group StudyGynecol Oncol2009112354355210.1016/j.ygyno.2008.11.0141:CAS:528:DC%2BD1MXisVOiu7s%3D19108877 – reference: WrightAANeoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice GuidelineGynecol Oncol2016143131510.1016/j.ygyno.2016.05.022276506845413203 – reference: KehoeSHookJNankivellMJaysonGCKitchenerHLopesTLuesleyDPerrenTBannooSMascarenhasMDobbsSEssapenSTwiggJHerodJMcCluggageGParmarMSwartAMPrimary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trialLancet201510.1016/s0140-6736(14)62223-626638963 – volume: 143 start-page: 3 issue: 1 year: 2016 ident: 3838_CR4 publication-title: Gynecol Oncol doi: 10.1016/j.ygyno.2016.05.022 – volume: 71 start-page: 431 year: 1998 ident: 3838_CR2 publication-title: Gynecol Oncol doi: 10.1006/gyno.1998.5213 – year: 2015 ident: 3838_CR9 publication-title: Lancet doi: 10.1016/s0140-6736(14)62223-6 – volume: 366 start-page: 591 year: 2005 ident: 3838_CR5 publication-title: Lancet doi: 10.1016/S0140-6736(05)67063-8 – volume: 136 start-page: 240 issue: 2 year: 2015 ident: 3838_CR10 publication-title: Gynecol Oncol doi: 10.1016/j.ygyno.2014.12.004 – volume: 101 start-page: 244 issue: 2 year: 2009 ident: 3838_CR7 publication-title: Br J Cancer doi: 10.1038/sj.bjc.6605157 – volume: 37 start-page: 327 year: 1990 ident: 3838_CR3 publication-title: Gynecol Oncol doi: 10.1016/0090-8258(90)90361-N – volume: 45 start-page: 225 issue: 2 year: 2009 ident: 3838_CR8 publication-title: Eur J Cancer doi: 10.1016/j.ejca.2008.10.026 – ident: 3838_CR1 – volume: 112 start-page: 543 issue: 3 year: 2009 ident: 3838_CR6 publication-title: Gynecol Oncol doi: 10.1016/j.ygyno.2008.11.014 |
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Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is a treatment strategy for ovarian cancer patients with unresectable... Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is a treatment strategy for ovarian cancer patients with unresectable disease or... ObjectivesNeoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is a treatment strategy for ovarian cancer patients with unresectable... |
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| SubjectTerms | Adult Aged Aged, 80 and over Cancer Research Chemotherapy Endometrial cancer Endometrial Neoplasms - drug therapy Endometrial Neoplasms - pathology Endometrium Female Humans Medicine Medicine & Public Health Middle Aged Neoadjuvant Therapy - methods Oncology Original Article Ovarian cancer Patients Pharmacology/Toxicology Surgery |
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| Title | Neoadjuvant chemotherapy in patients with advanced endometrial cancer |
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