Alexandra Taylor, MD
Greater knowledge of the molecular changes in advanced endometrial cancer has led researchers to investigate the activity of targeted therapies in this gynecologic landscape, particularly mTOR inhibitors and antiangiogenic agents.
Currently, the standard-of-care therapy for patients with advanced endometrial cancer is chemotherapy, or potentially complete cytoreduction, if eligible.
In a population that has a high rate of comorbidities, it is important to consider the patient’s quality of life during their treatment, said Alexandra Taylor, MD. Unfortunately, patient-reported outcomes and quality-of-life considerations remain an unmet need.
In an interview with OncLive
, Taylor, consultant, clinical oncology, The Royal Marsden Hospital, discussed the advances with targeted therapies in endometrial cancer, as well as the challenges that still exist in the treatment and management of patients with advanced disease.
OncLive: What is the current standard treatment for patients with advanced disease?
: Advanced endometrial cancer often covers a range of patients, and about 5% to 10% of patients present with advanced disease. We also have a cohort of patients who also develop recurrent and metastatic disease. Therefore, it is a wide range of presentations; they may be diagnosed after surgery, in terms of having microscopic disease, or they may present with very widespread disease and have a lot of lung or liver metastases at the time of presentation.
The sort of mainstay of treatment is chemotherapy. We need to give systemic treatment, but we also want to consider the different presentations in that, if someone presents with disease that can be surgically removed, we should debate about whether they should have surgery first. Ideally, they have complete cytoreduction, so they undergo surgery and then have chemotherapy.
We are looking at a diverse group of women. The results with surgery, when the patient undergoes cytoreduction, can be associated with a high risk of complications. We consider the alternative, which is to give neoadjuvant chemotherapy, select those patients who have chemotherapy-sensitive disease, and then [determine whether] complete cytoreduction is then feasible.
Are there any treatments currently in development?
It is quite an exciting time in the treatment of patients with endometrial cancer. We have a better knowledge of the molecular changes that can guide us toward specific pathways where targeted agents may have activity. We have had a lot of phase II studies looking at single-agent targeted therapies, particularly with the mTOR inhibitors targeting the PI3-kinase pathway, as well as the antiangiogenic agents.