Management Strategies for Recurrent Endometrial Cancer

INTRODUCTION

Endometrial cancer is the most common gynecologic malignancy in the developed world, and its incidence is increasing. Mortality from this cancer has not improved in recent decades and is primarily driven by high-grade carcinomas that are more likely to present at an advanced stage and ultimately are more likely to recur. The prognosis for recurrent endometrial cancer is poor, especially for the 50% of these women that present with extrapelvic disease recurrence. As a standard of care, recurrent disease has been treated with platinum-based chemotherapy; however, new therapies are emerging as we identify drivers of proliferation and metastasis at the cellular and molecular levels. Areas Covered: We review currently available data for the management of recurrent endometrial cancer, with a focus on systemic treatment of recurrent disease. We discuss the available evidence for first-line, second-line, and subsequent systemic therapy and discuss emerging therapeutic targets including their biologic plausibility and early clinical data. Expert Commentary: Endometrial cancer, though prevalent, remains underfunded and understudied. Recurrent and metastatic disease remains difficult to treat, and prospective randomized data are limited. Our ability to reduce mortality due to this cancer is dependent on identifying new and effective therapeutic strategies for recurrent disease.

Epidemiology and survival outcomes of mucinous adenocarcinomas: A SEER population-based study

To investigate the epidemiology, demographics and survival of mucinous adenocarcinomas (MACs), we identified 80,758 MAC patients in the Surveillance, Epidemiology and End Results (SEER) database. The reported incidence of MACs ebbed and flowed over time; however, a significant increase in reported annual age-adjusted incidences of MACs in the appendix, lung and bronchus was observed from 1981 to 2014. The demographics and outcomes of MACs differed by anatomic sites. MACs of the stomach had the largest percentage of poorly differentiated or undifferentiated tumors (41.2%), while MACs of the appendix and pancreas were associated with more advanced tumor stage (P < 0.001). MACs of the pancreas, lung and bronchus and stomach showed worse survival than other sites, despite localized, regional or distant stage (P < 0.001). In univariate and multivariate analysis, site, tumor grade, tumor stage, regional nodes, sex, race, surgery and year of diagnosis were identified as independent prognostic factors of cancer-specific survival. In conclusion, the incidence of MACs of certain specific sites, such as the appendix, lung and bronchus, is rapidly increasing. We also revealed a series of prognostic factors of MACs, including tumor sites, tumor grade and tumor stage, which may improve the current understanding of the clinical and biological patterns of MACs.