Endometrial cancer

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Hormone therapy for endometrioid histologies

Anastrozole (Arimidex)

given until progression of disease or unacceptable toxicity

References

  1. Rose PG, Brunetto VL, VanLe L, Bell J, Walker JL, Lee RB. A phase II trial of anastrozole in advanced recurrent or persistent endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2000 Aug;78(2):212-6. link to original article contains verified protocol PubMed

Medroxyprogesterone acetate (MPA)

Regimen

  • Medroxyprogesterone acetate (MPA) 200 mg PO daily

given until progression of disease or unacceptable toxicity

References

  1. Thigpen JT, Brady MF, Alvarez RD, Adelson MD, Homesley HD, Manetta A, Soper JT, Given FT. Oral medroxyprogesterone acetate in the treatment of advanced or recurrent endometrial carcinoma: a dose-response study by the Gynecologic Oncology Group. J Clin Oncol. 1999 Jun;17(6):1736-44. link to original article contains verified protocol PubMed

Medroxyprogesterone acetate (MPA) & Tamoxifen (Nolvadex)

Regimen

  • Medroxyprogesterone acetate (MPA) 100 mg PO BID on even-numbered weeks (for example, week 2, 4, 6, etc.)
  • Tamoxifen (Nolvadex) 20 mg PO BID

given until progression of disease or unacceptable toxicity

References

  1. Whitney CW, Brunetto VL, Zaino RJ, Lentz SS, Sorosky J, Armstrong DK, Lee RB; Gynecologic Oncology Group study. Phase II study of medroxyprogesterone acetate plus tamoxifen in advanced endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004 Jan;92(1):4-9. link to original article contains verified protocol PubMed

Megestrol acetate (Megace)

Regimen

  • Megestrol acetate (Megace) 80 mg PO BID

given until progression of disease or unacceptable toxicity

References

  1. Pandya KJ, Yeap BY, Weiner LM, Krook JE, Erban JK, Schinella RA, Davis TE. Megestrol and tamoxifen in patients with advanced endometrial cancer: an Eastern Cooperative Oncology Group Study (E4882). Am J Clin Oncol. 2001 Feb;24(1):43-6. link to original article contains verified protocol PubMed

Megestrol acetate (Megace) & Tamoxifen (Nolvadex)

Regimen

  • Megestrol acetate (Megace) 80 mg PO BID x 3 weeks, alternating with tamoxifen
  • Tamoxifen (Nolvadex) 20 mg PO BID x 3 weeks, alternating with megestrol

3-week courses of Megestrol acetate (Megace), alternating back and forth with 3-week courses of Tamoxifen (Nolvadex); given until progression of disease or unacceptable toxicity

References

  1. Fiorica JV, Brunetto VL, Hanjani P, Lentz SS, Mannel R, Andersen W; Gynecologic Oncology Group study. Phase II trial of alternating courses of megestrol acetate and tamoxifen in advanced endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004 Jan;92(1):10-4. link to original article contains verified protocol PubMed

Tamoxifen (Nolvadex)

Regimen

given until progression of disease or unacceptable toxicity

References

  1. Quinn MA, Campbell JJ. Tamoxifen therapy in advanced/recurrent endometrial carcinoma. Gynecol Oncol. 1989 Jan;32(1):1-3. PubMed
  2. Thigpen T, Brady MF, Homesley HD, Soper JT, Bell J. Tamoxifen in the treatment of advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group study. J Clin Oncol. 2001 Jan 15;19(2):364-7. link to original article contains verified protocol PubMed

Adjuvant radiation & chemotherapy

Cisplatin (Platinol), Doxorubicin (Adriamycin), RT

Regimen

Adjuvant radiation:

  • Radiation therapy to the pelvis, 1.8 Gy x 28 fractions for a total dose of 50.4 Gy
    • Patients with positive para-aortic lymph nodes received 1.5-1.8 Gy x 24-29 fractions for a total dose of 43.5 Gy

6-week course, begins within 8 weeks after surgery

Chemotherapy:

21-day cycles x 6 cycles, to start within 8 weeks after adjuvant radiation is complete

Supportive medications:

References

  1. Homesley HD, Filiaci V, Gibbons SK, Long HJ, Cella D, Spirtos NM, Morris RT, DeGeest K, Lee R, Montag A. A randomized phase III trial in advanced endometrial carcinoma of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: A Gynecologic Oncology Group study. Gynecol Oncol. 2009 Mar;112(3):543-52. Epub 2008 Dec 23. link to original article contains verified protocol PubMed

Cisplatin (Platinol), Doxorubicin (Adriamycin), Paclitaxel (Taxol), RT

Regimen

Adjuvant radiation:

  • Radiation therapy to the pelvis, 1.8 Gy x 28 fractions for a total dose of 50.4 Gy
    • Patients with positive para-aortic lymph nodes received 1.5-1.8 Gy x 24-29 fractions for a total dose of 43.5 Gy

6-week course, begins within 8 weeks after surgery

Chemotherapy:

21-day cycles x 6 cycles, to start within 8 weeks after adjuvant radiation is complete

Supportive medications:

References

  1. Homesley HD, Filiaci V, Gibbons SK, Long HJ, Cella D, Spirtos NM, Morris RT, DeGeest K, Lee R, Montag A. A randomized phase III trial in advanced endometrial carcinoma of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: A Gynecologic Oncology Group study. Gynecol Oncol. 2009 Mar;112(3):543-52. Epub 2008 Dec 23. link to original article contains verified protocol PubMed

Advanced or metastatic disease

Carboplatin (Paraplatin)

Regimen

28-day cycles

References

  1. van Wijk FH, Lhommé C, Bolis G, Scotto di Palumbo V, Tumolo S, Nooij M, de Oliveira CF, Vermorken JB; European Organization for Research and Treatment of Cancer. Gynaecological Cancer Group. Phase II study of carboplatin in patients with advanced or recurrent endometrial carcinoma. A trial of the EORTC Gynaecological Cancer Group. Eur J Cancer. 2003 Jan;39(1):78-85. link to original article contains verified protocol PubMed

Carboplatin (Paraplatin) & Paclitaxel (Taxol)

Regimen #1, Pectasides, et al. 2008

21-day cycles x 6-9 cycles

Regimen #2, Hoskins, et al. 2001 & Shechter-Maor, et al. 2008

21-day cycles

Regimen #3, Sorbe, et al. 2008

21-day cycles

References

  1. Hoskins PJ, Swenerton KD, Pike JA, Wong F, Lim P, Acquino-Parsons C, Lee N. Paclitaxel and carboplatin, alone or with irradiation, in advanced or recurrent endometrial cancer: a phase II study. J Clin Oncol. 2001 Oct 15;19(20):4048-53. link to original article contains verified protocol PubMed
  2. Pectasides D, Xiros N, Papaxoinis G, Pectasides E, Sykiotis C, Koumarianou A, Psyrri A, Gaglia A, Kassanos D, Gouveris P, Panayiotidis J, Fountzilas G, Economopoulos T. Carboplatin and paclitaxel in advanced or metastatic endometrial cancer. Gynecol Oncol. 2008 May;109(2):250-4. Epub 2008 Mar 4. link to original article contains verified protocol PubMed content property of HemOnc.org
  3. Sorbe B, Andersson H, Boman K, Rosenberg P, Kalling M. Treatment of primary advanced and recurrent endometrial carcinoma with a combination of carboplatin and paclitaxel-long-term follow-up. Int J Gynecol Cancer. 2008 Jul-Aug;18(4):803-8. Epub 2007 Oct 18. PubMed
  4. Shechter-Maor G, Bruchim I, Ben-Harim Z, Altaras M, Fishman A. Combined chemotherapy regimen of carboplatin and paclitaxel as adjuvant treatment for papillary serous and clear cell endometrial cancer. Int J Gynecol Cancer. 2009 May;19(4):662-4. link to original article PubMed

Cisplatin (Platinol) & Doxorubicin (Adriamycin)

Regimen #1, Fleming et al. 2004

21-day cycles x 7 cycles

Regimen #2, Randall et al. 2006

21-day cycles x 8 cycles

Supportive hydration:

  • Normal saline at 500 mL/H for 2 hours prior to and after cisplatin

References

  1. Fleming GF, Brunetto VL, Cella D, Look KY, Reid GC, Munkarah AR, Kline R, Burger RA, Goodman A, Burks RT. Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2004 Jun 1;22(11):2159-66. link to original article contains verified protocol PubMed
  2. Randall ME, Filiaci VL, Muss H, Spirtos NM, Mannel RS, Fowler J, Thigpen JT, Benda JA; Gynecologic Oncology Group Study. Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2006 Jan 1;24(1):36-44. Epub 2005 Dec 5. link to original article contains verified protocol PubMed

Cisplatin (Platinol), Doxorubicin (Adriamycin), Paclitaxel (Taxol)

Regimen

21-day cycles x 7 cycles

Supportive medications:

References

  1. Fleming GF, Brunetto VL, Cella D, Look KY, Reid GC, Munkarah AR, Kline R, Burger RA, Goodman A, Burks RT. Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2004 Jun 1;22(11):2159-66. link to original article contains verified protocol PubMed

Cisplatin (Platinol), Ifosfamide (Ifex), Mesna (Mesnex) (CIM) - GOG 150

Regimen

  • Cisplatin (Platinol) 20 mg/m2 IV at an infusion rate of approximately 1 mg/min on days 1-4, given first
  • Ifosfamide (Ifex) 1500 mg/m2 IV over 1 hour on days 1-4, given second together with mesna
  • Mesna (Mesnex) 120 mg/m2 IV bolus over 15 minutes, then 1500 mg/m2/day IV continuous infusion over 96 hours on days 1-4, given second together with ifosfamide

21-day cycles x 3 cycles

Supportive medications:

  • Suggested hydration: 1 liter of NS or 1/2 NS given over several hours prior to chemotherapy

References

  1. Wolfson AH, Brady MF, Rocereto T, Mannel RS, Lee YC, Futoran RJ, Cohn DE, Ioffe OB. A gynecologic oncology group randomized phase III trial of whole abdominal irradiation (WAI) vs. cisplatin-ifosfamide and mesna (CIM) as post-surgical therapy in stage I-IV carcinosarcoma (CS) of the uterus. Gynecol Oncol. 2007 Nov;107(2):177-85. Epub 2007 Sep 5. link to original article contains verified protocol PubMed

Cisplatin (Platinol) & Paclitaxel (Taxol)

Regimen

21-day cycles x up to 6 cycles

Supportive medications:

  • Dexamethasone (Decadron) 20 mg PO/IV 12 and 6 hours prior to paclitaxel
  • Diphenhydramine (Benadryl) 25 mg IV 30 minutes prior to paclitaxel
  • Ranitidine (Zantac) 50 mg IV 30 minutes prior to paclitaxel
  • 900 mL normal saline mixed with 100 mL mannitol given over 1 hour prior to cisplatin
  • 2 liters NS with potassium & magnesium after cisplatin
  • "Appropriate antiemetics"
  • Filgrastim (Neupogen) 5 mcg/kg SC daily, starting on day 5 and continuing until WBC >10,000

References

  1. Dimopoulos MA, Papadimitriou CA, Georgoulias V, Moulopoulos LA, Aravantinos G, Gika D, Karpathios S, Stamatelopoulos S. Paclitaxel and cisplatin in advanced or recurrent carcinoma of the endometrium: long-term results of a phase II multicenter study. Gynecol Oncol. 2000 Jul;78(1):52-7. link to original article contains verified protocol PubMed

Dactinomycin (Cosmegen)

Regimen

28-day cycles

References

  1. Moore DH, Blessing JA, Dunton C, Buller RE, Reid GC. Dactinomycin in the treatment of recurrent or persistent endometrial carcinoma: A Phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 1999 Dec;75(3):473-5. link to original article contains verified protocol PubMed

Ifosfamide (Ifex) & Paclitaxel (Taxol)

Regimen

Note: Homesley, et al. 2007 specifies that PO Mesna (Mesnex) is to be taken in 3 divided doses, but only lists 2 time points for its use. The timing of the middle dose is estimated based on other references.

  • Ifosfamide (Ifex) 1600 mg/m2 IV on days 1-3
  • Mesna (Mesnex) 2000 mg IV over 12 hours on days 1-3, starting 15 minutes before ifosfamide
    • Alternate PO dosing: Mesna (Mesnex) 1330 mg PO taken 1 hour before, 4 hours after, and 8 hours after ifosfamide (4000 mg total dose per day), on days 1-3
  • Paclitaxel (Taxol) 135 mg/m2 IV over 3 hours on day 1

21-day cycles x 8 cycles

Supportive medications:

  • Filgrastim (Neupogen) 5 mcg/kg SC daily starting on day 4, to continue until ANC is greater than or equal to 2000
  • Dexamethasone (Decadron) 20 mg PO/IV 12 and 6 hours prior to paclitaxel
  • Diphenhydramine (Benadryl) 50 mg IV 30 minutes prior to paclitaxel
  • Cimetidine (Tagamet) 300 mg IV or Ranitidine (Zantac) 50 mg IV 30 minutes prior to paclitaxel

References

  1. Homesley HD, Filiaci V, Markman M, Bitterman P, Eaton L, Kilgore LC, Monk BJ, Ueland FR; Gynecologic Oncology Group. Phase III trial of ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2007 Feb 10;25(5):526-31. link to original article contains verified protocol PubMed

Paclitaxel (Taxol)

Regimen #1, Lincoln, et al. 2003

21-day cycles

Supportive medications:

  • Dexamethasone (Decadron) 20 mg PO/IV 12 and 6 hours prior to paclitaxel
  • Diphenhydramine (Benadryl) 50 mg PO/IV 30 minutes prior to paclitaxel
  • Cimetidine (Tagamet) 300 mg IV 30 minutes prior to paclitaxel

Regimen #2, Lissoni, et al. 1996

21-day cycles

Supportive medications:

  • Hydrocortisone 250 mg IV 1 hour prior to paclitaxel
  • Chlorphenamine/chlorpheniramine (H1 blocker) 10 mg IM 1 hour prior to paclitaxel
  • Cimetidine (Tagamet) 300 mg IV 1 hour prior to paclitaxel

Regimen #3, Ball, et al. 1996

21-day cycles

Supportive medications:

  • Dexamethasone (Decadron) 20 mg PO/IV 12 and 6 hours prior to paclitaxel
  • Diphenhydramine (Benadryl) 50 mg PO/IV 30 minutes prior to paclitaxel
  • Cimetidine (Tagamet) 300 mg IV 30 minutes prior to paclitaxel
  • Filgrastim (Neupogen) 5 mcg/kg SC daily starting on day 3, 24 hours after chemotherapy, continued for at least 12 days or until two successive total leukocyte counts are 10,000 or greater, whichever comes last

References

  1. Ball HG, Blessing JA, Lentz SS, Mutch DG. A phase II trial of paclitaxel in patients with advanced or recurrent adenocarcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol. 1996 Aug;62(2):278-81. link to original article contains verified protocol PubMed
  2. Lissoni A, Zanetta G, Losa G, Gabriele A, Parma G, Mangioni C. Phase II study of paclitaxel as salvage treatment in advanced endometrial cancer. Ann Oncol. 1996 Oct;7(8):861-3. link to original article contains verified protocol PubMed
  3. Lincoln S, Blessing JA, Lee RB, Rocereto TF. Activity of paclitaxel as second-line chemotherapy in endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2003 Mar;88(3):277-81. link to original article contains verified protocol PubMed

Topotecan (Hycamtin)

Regimen

  • Topotecan (Hycamtin) 1.5 mg/m2 IV on days 1-5
    • Dosage for patients with previous pelvic radiation is Topotecan (Hycamtin) 1.2 mg/m2, which can be increase to the 1.5 mg/m2 dose in later cycles if there are no toxicities higher than grade 1

21-day cycles

References

  1. Wadler S, Levy DE, Lincoln ST, Soori GS, Schink JC, Goldberg G. Topotecan is an active agent in the first-line treatment of metastatic or recurrent endometrial carcinoma: Eastern Cooperative Oncology Group Study E3E93. J Clin Oncol. 2003 Jun 1;21(11):2110-4. link to original article contains verified protocol PubMed
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