The activity has been modest with single agents. We are seeing response rates up to 20% with mTOR inhibitors in chemotherapy-naïve patients, and similarly with the antiangiogenic agents—such as bevacizumab (Avastin)—which demonstrated a response rate of about 13%. As a single agent, there may be limited benefit. However, in the future, we are looking to combine these therapies either with alternative agents or standard chemotherapy.
What challenges do you face in managing this particular patient population?
Women with endometrial cancer, as a population, have a high instance of comorbidities. A lot of endometrial cancer is estrogen driven. We know that more than 80% are obese, and there is a high instance of diabetes, cardiovascular disease, arthritis, and poor [renal] function. Therefore, we must individualize treatment for these women, and we must be conscious that our treatment is taking into account the comorbidities and quality of life of our patients.
What do you believe is the biggest unmet need in endometrial cancer?
I really need to highlight the lack of quality-of-life and patient-reported outcomes alongside these new potential treatments. At the moment, we have treatments where the survival benefits are very modest; however, the treatment can have a huge impact on a woman's quality of life. We need to work with patients to develop strategies that optimize their quality of life alongside our treatments.
What do you hope that community oncologists understand about the treatment and management of their patients with advanced endometrial cancer?
There are 2 things. There are exciting treatments coming forward, both in terms of systemic targeted agents and new radiotherapy and surgical techniques. Therefore, I hope that we can look forward to optimizing these [approaches]. The other, bigger message would be the importance of assessing our patients and developing strategies that look to work with patients in terms of quality of life.
Is there anything else that you would like to highlight?
I am very much interested in looking at the new techniques of management of patients with recurrent disease, especially with local therapies. Again, where we have been concentrating on the management of systemic treatment, we are looking at radiation techniques—specifically stereotactic radiotherapy as a way of significantly improving our local control of recurrent or inoperable disease while minimizing toxicity. We are looking to develop that in new clinical trials.