CHEMOTHERAPY HAS a role in the management of endometrial cancer both in newly diagnosed patients with a high risk of relapse and in patients with recurrent disease. High-risk newly diagnosed patients include the 15% of patients who present with surgical stage IIIB or higher disease. The 5-year overall survival rate is 42% to 59% in the presence of stage IIIC disease and 18% to 30% for stage IV disease. A second high-risk group comprises those with stage III or IV cancers of papillary serous histology, of whom less than 25% will be long-term survivors.

The most current information is from the NCCN guidelines (go here).

There is no consensus regarding the optimal chemotherapy, but the combination of cisplatin plus doxorubicin (Adriamycin so AC)   is commonly used. The results from Gynecologic Oncology Group Trial 107 showed a  higher response rate (44% v 28%) and longer progression-free interval with cisplatin-doxorubicin compared with doxorubicin alone.

 

 
Paclitaxel (Taxol) attracted attention for use in patients with endometrial cancer because of its success in ovarian and breast cancers. Three studies, all reported in 1996, demonstrated response rates of 36% to 43% when paclitaxel was used as a single agent. Importantly, activity was demonstrated in truly platin-resistant patients. GOG 177 showed that  AC+ Taxol (ACT) was superior to AC. Lower risk patients (IA grade 3, IB, IC, II  benefit from postOp pelvic irradiation (GOG 99 survival improved 89%/3y to 96%/3y) but as noted in GOG 122 high risk patients need chemotherapy (AC or ACT) if they can tolerate it. As noted below the GOG 0189 trial compares the best chemotherapy (adria/platinol/taxol) with hormonal therapy (Tamoxifen/Megace.)

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The GOG 122 Protocol (Stage III/IV with <2cm postOp residual tumor) compared postOp chemo (Adriamycin 60mg/m2 and cisplatin 50mg/m2 q 21d X 7) versus radiation (WAR 30Gy/20fx + pelvic boost 15Gy and nodal boost) and found chemotherapy was superior with 30%   lower progression rate and 34% lower death rate.
some of the Current GOG protocols including chemotherapy for endometrial cancer:

GOG0177 A RANDOMIZED STUDY OF DOXORUBICIN PLUS CISPLATIN VERSUS DOXORUBICIN PLUS CISPLATIN PLUS 3-HOUR PACLITAXEL WITH G-CSF SUPPORT IN PATIENTS WITH PRIMARY STAGE III & IV OR RECURRENT ENDOMETRIAL CARCINOMA (Gini Fleming)

GOG0184 Tumor Volume-Directed Pelvic Plus or Minus Para-Aortic Irradiation followed by Cisplatin and Doxorubicin or Cisplatin, Doxorubicin and Paclitaxel for advanced Endometrial Carcinoma (Howard D Homesley)

GOG0188 Phase II Study of Faslodex in Advanced/Recurrent Endometrial Cancer (Allan L Covens)

GOG0189 RANDOMIZED PHASE III CROSSOVER TRIAL OF CHEMOTHERAPY (DOXORUBICIN/CISPLATIN/PACLITAXEL and G-CSF) VERSUS HORMONAL THERAPY (TAMOXIFEN/MEGESTROL ACETATE) IN PATIENTS WITH STAGE III & IV OR RECURRENT ENDOMETRIAL CANCER (Jeffrey Bloss)

Paclitaxel and Carboplatin, Alone or With Irradiation, in Advanced or Recurrent Endometrial Cancer: A Phase II Study
By Paul J. Hoskins, Journal of Clinical Oncology, Vol 19, Issue 20 (October), 2001: 4048-4053

To evaluate the efficacy of carboplatin plus paclitaxel in primarily advanced or recurrent endometrial cancers.Four distinct patient groups received carboplatin (area under the curve, 5 to 7) plus paclitaxel 175 mg/m2 for 3 hours at 4-week intervals: group 1 (n = 21), patients with primarily advanced, nonpapillary serous cancers; group 2 (n = 20), the same as group 1 but with papillary serous cancers; group 3 (n = 18), recurrent, nonpapillary serous cancers; and group 4 (n = 4), recurrent, papillary serous cancers. Involved-field irradiation was used in groups 1 and 2 for those with radioencompassable disease.

RESULTS: Sixty-three patients were treated. Response rates to chemotherapy in the assessable patients in the four groups were 78%, 60%,, 56%, and 50%, respectively. Nineteen patients (90%) in group 1 also were irradiated, and the median failure-free survival time for all 21 patients was 23 months, with a 62% 3-year overall survival rate. Eleven patients (55%) in group 2 were irradiated, and the median failure-free survival time for all 18 patients was 18 months, with a 39% 3-year overall survival rate. The median failure-free interval in the patients in group 3 was 6 months, with a 15-month median overall survival time. Toxicity was manageable, reversible, and predominantly hematologic. Two patients developed neutropenic fever, and three patients, including these two, were hospitalized for complications.

CONCLUSION: Carboplatin-paclitaxel is an efficacious, low-toxicity regimen for managing primarily advanced or recurrent endometrial cancers.
Are these results any different from those achieved with cisplatin and doxorubicin? In the absence of a randomized comparison, one can only compare this regimen with other series, with all the pitfalls inherent in such an approach. Additionally, we included involved-field irradiation in the majority of our primarily advanced patients. For the papillary serous cancers, the comparison is with cisplatin, doxorubicin, and cyclophosphamide.. The response rates were higher with carboplatin and paclitaxel (50% to 82% v 18% to 27%). The median survivals were similar but favored carboplatin and paclitaxel. When comparing outcomes in patients with nonpapillary serous histologies, the response rates with platinum and paclitaxel were superior to those with cisplatin and doxorubicin (67% v 52%).