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Title: Combination Chemotherapy May Have Greater Benefit to Advanced Endometrial Cancer, But Higher Toxicity: Presented at ASCO

"Combination Chemotherapy May Have Greater Benefit to Advanced Endometrial Cancer, But Higher Toxicity: Presented at ASCO"

By Ed Susman CHICAGO, IL -- June 3, 2003 -- Chemotherapy appears to show a survival advantage over radiation in treatment for advanced endometrial cancer, say researchers. However, the toxicity related to chemotherapy may contribute to fewer patients completing their treatment course. A 10-year study of outcomes comparing the 2 treatments was reported at the 39th Annual Meeting of the American Society of Clinical Oncology. The study recruited 422 patients from May 1992 to February 2000, and eventually 396 patients participated in the trial -- 202 received whole abdominal radiation and 194 received a chemotherapy treatment course combining cisplatin and doxorubicin following total hysterectomy. In an oral presentation, Marcus Randall, MD, chairman of the department of radiation oncology and professor of radiation oncology at the University of Indiana, Indianapolis, United States, said that 51.5% of patients receiving chemotherapy remained disease free after 24 months compared with 46.5% of patients who received radiotherapy. "The risk of a patient having recurrence was reduced by 32% if the woman was receiving chemotherapy," Dr. Randall said. But he noted that overall, more than half of the women in the trial had their cancer recur. In a scheduled discussion of Dr. Randall's report, Gillian Thomas, MD, professor of radiation oncology and obstetrics and gynaecology at the University of Toronto, Canada, said that patients who underwent chemotherapy paid for the decrease in recurrence with an increase in toxicity. In fact, Dr. Randall said that 84% of patients completed the radiation course, but only 63% of the patients on the chemotherapy regimen completed it. About 3% of the radiation patients said they discontinued due to adverse events compared with 17% of the chemotherapy patients. Dr. Thomas said doctors could take away from the study -- performed under the auspices of the Gynecologic Oncology Group -- the message that cisplatin-doxorubicin was standard of care in advanced endometrial cancer; that radiation therapy is ineffective; or that the chemotherapy regimen is too toxic. "We have learned a lot from the study," she said, even though she had numerous questions about the methodology and whether higher doses of radiotherapy might not have made differences in outcome. "Doctors and patients will have to decide if the modest benefit in disease-free survival after 2 years is balanced by the high toxicity and high drop-out rate," she said. However, Dr. Thomas suggested that the combination of radiation and chemotherapy might prove to be a better course of treatment for these women. Dr. Randall said another Gynecologic Oncology Group study using the combination is underway. [Study title: Whole Abdominal Radiotherapy Versus Combination Doxorubicin-Cisplatin Chemotherapy in Advanced Endometrial Carcinoma: A Randomized Phase III Trial of the Gynecologic Oncology Group. Abstract 3]

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