by Vera Martinella
Two studies in women with advanced or recurrent cancer indicate that the combination of treatments reduces the risk of disease progression and also lengthens the time before a relapse
Little is said about it, but endometrial cancer is the most common gynecological cancer in the United States and Europe and both cases and mortality are increasing. If diagnosed and treated at an early stage, the prognosis is good and around 80% of patients are still alive 5 years after diagnosis, but in around a fifth of cases the neoplasm is particularly aggressive. However, two studies presented at the annual congress of the European Society for Medical Oncology (Esmo, European Society for Medical Oncology), underway in Madrid, show that the addition of immunotherapy to standard chemotherapy significantly delays relapse in women with cancer in an advanced stage or already relapsed.
Symptoms not to be overlooked
In Italy there are approximately 10 thousand new diagnoses of endometrial cancer every year, the fourth most frequent cancer in the female population after breast, colon and lung cancers. «The incidence is greater in women of menopausal age – explains Domenica Lorusso, head of Clinical Research Programming at the Gemelli IRCCS University Polyclinic Foundation in Rome and Full Professor of Gynecology and Obstetrics at the Humanitas University of Milan -: it occurs mainly around the age of 55-65 years (average age 60 years) and only in 25% of cases before menopause has begun, it is in fact rare before the age of 40. Metrorrhagia, or abnormal uterine bleeding regardless of the menstrual cycle or in post-menopause, is the first alarm bell: for this reason, blood loss, especially in post-menopausal women, should be a reason for rapid and thorough investigation” .
Yellowish-white vaginal discharge (leucoxanthorrhea), abdominal pain and swelling (edema) of the lower limbs are more characteristic of an advanced stage neoplasm. «It is essential that even during menopause the symptoms are not underestimated and gynecological checks are carried out – recalls Nicoletta Colombo, director of the Gynecology Oncology Program at the European Institute of Oncology (Ieo) in Milan -. Most diagnoses occur in the initial stage of the disease precisely because women promptly report abnormal blood tests. Ultrasound and hysteroscopy then provide the definitive diagnosis.”
The two searches
However, the phase three trial (the last before the final approval and entry into the market of a medicine) DUO-E concerns women with a new diagnosis of advanced or recurrent epithelial endometrial carcinoma. The prognosis for cases of recurrence is not good and mortality remains high, which is why effective therapies are needed.
«The trial enrolled 700 women – says Lorusso, who presented the results at Esmo 2023 -, who were divided into three groups: one received only the current standard treatment (chemotherapy), which works very well on a 30 % of patients, those who present the so-called “microsatellite instability”; the second group was treated with chemo and the immunotherapy durvalumab and the third with chemo plus durvalumab plus olaparib, a Parp inhibitor drug. The results indicate that this third option offers benefits to the remaining 70% of women, for whom for a long time there was nothing other than chemo, which however did not give great results. Now for the first time we are making progress and with durvalumab plus olaparib (added to chemotherapy) the risk of disease progression or death is reduced by 45% compared to chemotherapy alone. It should also be underlined that the benefits tend to last over time and we expect to see an improvement in survival.”
Another study, presented in Madrid by Nicoletta Colombo, reports the results obtained in advanced or recurrent endometrial cancer by administering the immunotherapy drug atezolizumab in combination with chemotherapy (carboplatin and paclitaxel): «The trial included 551 patients and the results confirm the great benefit of the addition of an immunotherapy, in this case atezolizumab, to standard chemotherapy in patients with metastatic and recurrent endometrial cancer, especially in those in which the tumor has a specific characteristic (MMR deficiency, mismatch repair) – explains Colombo – . In practice, the data indicates that with this strategy, disease progression-free survival improves (i.e. the time between the end of the treatment cycle and the moment in which the tumor recurs) and overall survival is also extended.”
Who risks more
«About 3 thousand Italians die every year from this neoplasm which, being considered to have a good prognosis, has not seen major investments in research and treatments – concludes Saverio Cinieri, president of Aiom, the Italian Association of Medical Oncology -. The consequence is that today it is the only oncological pathology with increasing mortality. In 80% of cases the diagnosis occurs when it is confined within the uterus, but in relapse, in an advanced form, the median survival is three years. Until yesterday we only had chemotherapy with carboplatin and taxol, but clinical research in recent years has developed innovative treatments.”
Who is most at risk of getting sick? «Obesity, diabetes, hypertension, late menopause, intake of estrogens not balanced by progestins increase the chances of getting sick – replies the expert -. The risk is also higher for women who take tamoxifen, a drug used in breast cancer therapy, and in those who have received previous radiation therapy on the pelvis. The reason behind the increased danger for these categories of people lies in the increased amount of estrogen which, in all these cases, stimulates the endometrium improperly. Finally, a greater genetic and familial predisposition also plays a role in the onset of the neoplasm.”
October 23, 2023 (modified October 24, 2023 | 2.46 pm)
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