David G. Mutch, MD
Following the results of a number of clinical studies, researchers are still debating the role of radiation therapy for patients with high-risk endometrial cancer.
during the 2018 Society of Gynecologic Oncology Annual Winter Meeting, Mutch, the Ira C. and Judith Gall Professor, vice chair of obstetrics and gynecology, chief of the Division of Gynecologic Oncology, Washington University School of Medicine in St. Louis, Siteman Cancer Center, discussed ongoing questions surrounding the role of radiation therapy for patients with high-risk endometrial cancer.
OncLive: Please discuss the use of external beam radiation therapy in high-risk patients with endometrial cancer.
I am in a debate [at this meeting] on whether there is utility in giving patients with high-risk endometrial cancer radiation therapy. My argument against this is supported by several trials beginning with GOG-99, which identified a high- and intermediate-risk group of patients with endometrial cancer. There was a decreased risk of central disease but not an OS benefit to postoperative external beam radiation therapy.
Therefore, chemotherapy and/or targeted therapy is clearly the way to treat this group of patients. We need to define our groups better. There are efforts underway to make that happen. PORTEC-4a for instance, is utilizing molecular data to stratify patients. We will anxiously await that data. We had a clinical trial planning meeting and proceeds of that were published recently. That will also help us develop new trials for targeted therapy.
Speaking on the molecular data, are there any biomarkers that can help determine which treatment to give?
Unfortunately, there are not. We have not gone far in utilizing conventional markers. Conventional markers would be lymphovascular space involvement, depth of invasion, grade of the tumor, or histologic type—whether it is papillary, serous, or clear cell. Those would typically be done.
We do have molecular data from The Cancer Genome Atlas study showing that patients who have a POLE
[polymerase epsilon] mutation, though they often have poorly differentiated tumors, almost never recur. If we routinely screen for POLE
mutations, those patients do not need adjuvant therapy.
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