Chemotherapy for Endometrial Cancer in Adjuvant and Advanced Disease Settings
Chemotherapy for Endometrial Cancer in Adjuvant and Advanced Disease Settings
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DOI：
10.1634/theoncologist.2016-0062
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发表时间：
2016-10-01
期刊：
影响因子：
5.8
通讯作者：
Fleming, Gini F.
中科院分区：
文献类型：
--
作者：
Bestvina, Christine M.;Fleming, Gini F.
尽管随机试验的结果各不相同，但IIIC期子宫内膜癌（淋巴结阳性）使用辅助化疗的证据仍为I级。化疗也经常被推荐用于I期疾病的高风险子集，如浆液性癌，尽管缺乏验证这种做法的前瞻性试验数据。根据转移性疾病的外推数据，卡铂加紫杉醇是目前的标准治疗方案。几项临床试验比较了单独的辅助盆腔放疗与放疗和化疗的组合，结果喜忧参半。其中最大的试验之一，子宫内膜癌术后放射治疗3（PORTEC-3），已完成招募，正在等待数据成熟。转移性疾病是无法治愈的。对于复发时间较长的低级别类胶质瘤，以孕激素为基础的内分泌治疗是合适的。化疗将用于大多数其他情况下，和标准的一线方案是卡铂和紫杉醇。少数化疗药物已被证明在二线治疗中产生有意义的缓解率。已经研究了分子靶向疗法，如mTOR抑制剂和抗血管生成剂，包括贝伐单抗，但它们在医疗设备中的作用仍不确定。
Level I evidence exists for use of adjuvant chemotherapy in stage IIIC endometrial cancer (positive lymph nodes), although results of randomized trials have varied. Chemotherapy is also often recommended for high-risk subsets of stage I disease, such as serous carcinomas, although prospective trial data to validate this practice are lacking. Carboplatin plus paclitaxel is the current standard regimen, based on extrapolation of data from the metastatic setting. Several clinical trials have compared adjuvant pelvic radiotherapy alone to a combination of radiotherapy and chemotherapy with mixed results. One of the largest of these trials, Postoperative Radiation Therapy in Endometrial Carcinoma 3 (PORTEC-3), has completed accrual and is awaiting data maturation. Metastatic disease is not curable. For tumors of low-grade endometrioid histology with a prolonged time to recurrence, endocrine therapy with a progestin-based regimen is appropriate. Chemotherapy will be used in most other cases, and the standard first-line regimen is carboplatin and paclitaxel. Few chemotherapy agents have been shown to produce meaningful response rates in the second-line setting. Molecularly targeted therapies such as m TOR inhibitors and antiangiogenic agents including bevacizumab have been studied but their role in the armamentarium remains uncertain.