David Mutch, MD, Ira C. and Judith Gall professor, vice chair of obstetrics and gynecology, chief, Division of Gynecologic Oncology, Washington University School of Medicine in St. Louis, Siteman Cancer Center, discusses frontline treatment for patients with endometrial cancer.

In patients who have high-risk endometrial cancer, Mutch argues that based on GOG-209, which randomized patients to cisplatin, paclitaxel, and doxorubicin versus carboplatin and paclitaxel, the survival is the same in both arms. Toxicity is greater in the triplet therapy group; therefore, standard therapy for upfront treatment would be carboplatin and paclitaxel in the high-risk patients.

However, patients need to be monitored for a cuff recurrence. Cuff recurrences, if monitored carefully, have a cure rate of 100%. Then, radiation therapy is certainly indicated.

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Dr. Mutch on Frontline Treatment in Endometrial Cancer

David Mutch, MD, Ira C. and Judith Gall professor, vice chair of obstetrics and gynecology, chief, Division of Gynecologic Oncology, Washington University School of Medicine in St. Louis, Siteman Cancer Center, discusses molecular biomarkers in endometrial cancer.

There are currently no molecular markers for determining which treatment to give a patient with endometrial cancer, explains Mutch. The field has not had success in utilizing conventional marker such as lymphovascular space involvement, depth of invasion, grade of the tumor, or histologic type—whether it is papillary, serous, or clear cell.

However, there is molecular data from The Cancer Genome Atlas study showing that patients who have a 

 [polymerase epsilon] mutation—though they often have poorly differentiated tumors&mdash;almost never recur, says Mutch. If patients are routinely screened for 

 mutations, those patients do not need adjuvant therapy. By utilizing molecular characterizations, it is possible to eliminate many patients who might not need any additional therapy, Mutch explains.

David Mutch, MD, Ira C. and Judith Gall professor, vice chair of obstetrics and gynecology, chief, Division of Gynecologic Oncology, Washington University School of Medicine, Siteman Cancer Center, discusses molecular biomarkers in endometrial cancer.

Dr. Mutch on Biomarkers in Endometrial Cancer

David Mutch, MD, Ira C. and Judith Gall professor, vice chair of obstetrics and gynecology, chief, Division of Gynecologic Oncology, Washington University School of Medicine, Siteman Cancer Center, discusses whether or not a patient with high-risk endometrial cancer should receive external beam radiation therapy.

There are several trials that suggest that patients with high-risk endometrial cancer should not receive external beam radiation. GOG-99 identified a high- and intermediate-risk group of patients with endometrial cancer. The findings of which showed a decreased risk of central disease but not an overall survival benefit to post-operative external beam radiation therapy.

According to Mutch, it became standard of care to give radiation therapy to this group because it decreased the risk of local recurrence, but the overall survival was the same.

That theme has been carried through the European trial PORTEC-1, with data showing that vaginal brachytherapy will decrease the local recurrence rate, as will external beam radiation therapy. However, there are more complications associated with external beam radiation therapy, prompting the Europeans to choose brachytherapy in this group of patients.

David Mutch, MD

Articles

Dr. Mutch on Frontline Treatment in Endometrial Cancer

Dr. Mutch on Biomarkers in Endometrial Cancer

Dr. Mutch Discusses Radiation Versus Targeted Therapy in Endometrial Cancer