Advanced Endometrial Cancer - Episode 1

Overview of Endometrial Cancer

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Bradley J. Monk, MD, FACS, FACOG: Hello, and welcome to this OncLive® Peer Exchange® titled “Advanced Endometrial Cancer.” This is OncLive®’s first endometrial cancer discussion. I am so excited to be here. My name is Brad Monk from the University of Arizona and Creighton University, both in Phoenix, Arizona. I’m also part of the US Oncology Network. My hospital is St Joseph’s Hospital and Medical Center in downtown Phoenix. I am joined today by 4 experts in the field from very prestigious academic medical centers. First is Dr Kathleen Moore. I’m going to call her Katie. Dr Moore is at the University of Oklahoma Stephenson Cancer Center. Katie, hello.

Kathleen N. Moore, MD: Hello. Thank you for having me.

Bradley J. Monk, MD, FACS, FACOG: Thank you. Dr Dave O’Malley from The Ohio State University Wexner Medical Center in Columbus, Ohio. Dave, welcome my brother.

David M. O’Malley, MD: Excited to be here for this inaugural endometrial cancer discussion.

Bradley J. Monk, MD, FACS, FACOG: Thank you. Dr Brian Slomovitz from Florida International University Herbert Wertheim College of Medicine and Broward Health in Fort Lauderdale, Florida. Brian, welcome.

Brian M. Slomovitz, MD: Thank you very much for having me, Brad. It’s really an honor.

Bradley J. Monk, MD, FACS, FACOG: You look very smart with all those plaques behind you, Brian.

Brian M. Slomovitz, MD: Thank you. Thanks.

Bradley J. Monk, MD, FACS, FACOG: Thank you. Dr Krishnansu Tewari from the University of California, Irvine. I’m going to call you Krish. Thank you. Welcome, my friend.

Krishnansu S. Tewari, MD: Thanks for having me, Brad.

Bradley J. Monk, MD, FACS, FACOG: This is exciting. As I think all of you are aware, there have been several important advances in understanding endometrial cancer, both from a biologic standpoint but also from a novel therapeutic standpoint. We’re beginning to define frontline treatment, and now we have options in recurrent disease. We’re going to review these options, from a surgical, regional, and systemic opportunity. I’d like to get started on our first topic, and that is to consider the biology and the prevalence and incidence of endometrial cancer or uterine corpus cancer.

Krish, why don’t you go ahead and start about the increasing incidence of endometrial cancer and how that has affected your practice.

Krishnansu S. Tewari, MD: Thank you, Brad. In 7 to 8 years we’ve seen about a 30% increase in the incidence of this disease in the United States. There are about 65,000 new cases anticipated for 2020. Maybe 8 years ago there was 45,000. So it’s an increased incidence. It accounts for probably 30% to 40% of my surgical practice, doing surgery for endometrial cancer. We’re not sure why the incidence is increasing. Certainly, for patients who are overweight, obese, and morbidly obese, not only has that been holding stable, but those conditions have been rising.

Diabetes is pretty stable, but what’s interesting is that ever since the Women’s Health Initiative was published in 2002, there’s been a decrease in the use of combined hormone replacement therapy. There’s a possible association between lack of progestins and the rise of endometrial cancer. Also, there are fewer hysterectomies being done for benign disease. Those 2 things need to be looked at in more detail. But predominantly, the obesity crisis in the United States is driving the higher incidence.

Bradley J. Monk, MD, FACS, FACOG: It is the most common operation that I do. Virtually all these operations are done minimally invasive. Katie Moore, your partner, Joan Walker, did that pivotal trial called LAP2.

Kathleen N. Moore, MD: Yeah.

Bradley J. Monk, MD, FACS, FACOG: Do you ever make an incision for an endometrial cancer? There’s been this evolution in cervical cancer that minimally invasive is not good in cervical cancer. But it’s still OK in endometrial, right?

Kathleen N. Moore, MD: Right. Yes, occasionally make an incision, certainly if we can’t do it laparoscopically or more accurately robotically, we get the uterus out the old-fashioned way. But it’s pretty uncommon.

Bradley J. Monk, MD, FACS, FACOG: It’s still not outlawed, but maybe someday open hysterectomy for endometrial cancer will be outlawed.

Kathleen N. Moore, MD: It’s really interesting that you’re bringing that up, Brad. Dave can probably comment on this. Actually, all of us can as fellowship directors. When I do the numbers for the fellows now, they do not have a lot of open notes.

Bradley J. Monk, MD, FACS, FACOG: That’s right. With sentinel lymph nodes now…

Kathleen N. Moore, MD: With sentinels, yeah.

Bradley J. Monk, MD, FACS, FACOG: Even more common lymphadenectomy is rare.

Transcript Edited for Clarity