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Debate 31A - What is the Best Adjuvant Therapy for Management of Stage III Endometrial Cancer?

Chemotherapy Alone

from Section IV - Endometrial Cancer

Published online by Cambridge University Press:  20 July 2023

Dennis S. Chi
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York
Nisha Lakhi
Affiliation:
Richmond University Medical Center, Staten Island
Nicoletta Colombo
Affiliation:
University of Milan-Bicocca
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Summary

The introduction of molecular profiling into the management of endometrial cancer would be premature, unjust, and frankly unnecessary. Prospective randomized control trials proving the utility of molecular profiling are an absolute necessity before the wide implementation of this prognostic stratification. As yet these do not exist. Endometrial cancer occurs throughout the world and across all socioeconomic classes. As such, any approach to the management of endometrial cancer should be accessible to all. Molecular profiling is an expensive, highly specialized technique. Any introduction of this technology into the management of endometrial cancer would lead to significant inequity across the globe. Finally, the vast majority of endometrial cancers are adequately classified using histopathology and immunohistochemistry both of which are available worldwide in a cost-effective and reproducible manner. Until prospective randomized controlled trials show that the implementation of molecular profiling into the management of endometrial cancer improves survival and reduces treatment-related morbidity we should temper our enthusiasm.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Randall, ME, et al. Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group study. J Clin Oncol 2006;24:3644.CrossRefGoogle ScholarPubMed
Homesley, HD, et al. A 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 study. Gynecol Oncol 2009;112:543552.CrossRefGoogle ScholarPubMed
de Boer, SM, et al. Adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): final results of an international, open-label, multicentre, randomised, phase 3 trial. Lancet Oncol 2018;19(3):295309.CrossRefGoogle ScholarPubMed
de Boer, SM, et al. Adjuvant chemoradiotherapy versus radiotherapy alone in women with high-risk endometrial cancer (PORTEC-3): patterns of recurrence and post-hoc survival analysis of a randomised phase 3 trial. Lancet Oncol 2019;20:12731285.CrossRefGoogle ScholarPubMed
Matei, D, et al. Adjuvant chemotherapy plus radiation for locally advanced endometrial cancer. N Engl J Med 2019;380:23172326.CrossRefGoogle ScholarPubMed

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