Uterine cancer

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23 regimens on this page
28 variants on this page

Contents


Guidelines

ESMO

NCCN

Endocrine therapy for endometrioid histologies

Anastrozole (Arimidex)

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Regimen

Study Evidence
Rose et al. 2000 Phase II

Endocrine therapy

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)

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Regimen

Study Evidence Comparator Efficacy
Thigpen et al. 1999 Phase III High-dose medroxyprogesterone acetate Seems not superior

Endocrine therapy

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 & Tamoxifen

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Regimen

Study Evidence
Whitney et al. 2004 Phase II

Endocrine therapy

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)

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Regimen

Study Evidence Comparator Efficacy
Pandya et al. 2001 (E4882) Randomized Phase II Megestrol acetate & Tamoxifen Seems not superior

Endocrine therapy

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 & Tamoxifen

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Regimen

Study Evidence Comparator Efficacy
Pandya et al. 2001 (E4882) Randomized Phase II Megestrol acetate Seems not superior

Endocrine therapy

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. 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
  2. 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 SD article contains verified protocol PubMed

Tamoxifen (Nolvadex)

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Regimen

Study Evidence
Quinn et al. 1989 Phase II
Thigpen et al. 2001 Phase II

Endocrine therapy

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. link to SD article 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

RT -> Cisplatin & Doxorubicin

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RT: Radiation Therapy
CD: Cisplatin & Doxorubicin

Regimen

Study Evidence Comparator Efficacy
Homesley et al. 2008 (GOG 184) Phase III Cisplatin, Doxorubicin, Paclitaxel, RT Seems not superior

Note: for chemotherapy, body surface area capped at 2.0 m2. Radiation is to begin within 8 weeks after surgery.

Radiotherapy

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

6-week course, followed within 8 weeks by:

Chemotherapy

Supportive medications

21-day cycle for 6 cycles

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 link to PMC article contains verified protocol PubMed

RT -> Cisplatin, Doxorubicin, Paclitaxel

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RT: Radiation Therapy
CDP: Cisplatin, Doxorubicin, Paclitaxel

Regimen

Study Evidence Comparator Efficacy
Homesley et al. 2008 (GOG 184) Phase III Cisplatin, Doxorubicin, RT Seems not superior

Note: for chemotherapy, body surface area capped at 2.0 m2. Radiation is to start within 8 weeks after surgery.

Radiotherapy

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

6-week course, followed within 8 weeks by:

Chemotherapy

Supportive medications

21-day cycle for 6 cycles

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 link to PMC article contains verified protocol PubMed

Advanced, recurrent, or metastatic disease

Bevacizumab (Avastin)

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Regimen

Study Evidence
Aghajanian et al. 2011 Phase II

Chemotherapy

21-day cycles, given until progression of disease or unacceptable toxicity

References

  1. Aghajanian C, Sill MW, Darcy KM, Greer B, McMeekin DS, Rose PG, Rotmensch J, Barnes MN, Hanjani P, Leslie KK. Phase II trial of bevacizumab in recurrent or persistent endometrial cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2011 Jun 1;29(16):2259-65. Epub 2011 May 2. link to original article contains verified protocol PubMed

Carboplatin (Paraplatin)

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Regimen

Study Evidence
van Wijk et al. 2003 Phase II

Chemotherapy

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 & Doxorubicin liposomal

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Regimen

Study Evidence
Pignata et al. 2007 (END-1) Phase II

Chemotherapy

Supportive medications

  • "No prophylactic use of G-CSF was recommended. In case of grade 4 neutropaenia, even without fever, therapeutic and prophylactic use of G-CSF was allowed."

28-day cycle for 3 to 6 cycles

All patients received 3 cycles of therapy. If there was no unacceptable toxicity, patients with stable or responsive disease received an additional 3 cycles.

References

  1. Pignata S, Scambia G, Pisano C, Breda E, Di Maio M, Greggi S, Ferrandina G, Lorusso D, Zagonel V, Febbraro A, Riva N, De Rosa V, Gallo C, Perrone F; Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies Group. A multicentre phase II study of carboplatin plus pegylated liposomal doxorubicin as first-line chemotherapy for patients with advanced or recurrent endometrial carcinoma: the END-1 study of the MITO (Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies) group. Br J Cancer. 2007 Jun 4;96(11):1639-43. Epub 2007 May 8. link to PMC article contains verified protocol PubMed

Carboplatin & Paclitaxel

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Regimen #1

Study Evidence
Pectasides et al. 2008 Phase II

Chemotherapy

21-day cycle for 6 to 9 cycles

Regimen #2

Study Evidence
Hoskins et al. 2001 Phase II

Chemotherapy

21-day cycles

Regimen #3

Study Evidence
Sorbe et al. 2008 Phase II

Chemotherapy

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. link to original article contains verified protocol PubMed
  4. Retrospective: 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 & Doxorubicin

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AP: Adriamycin (Doxorubicin) & Platinol (Cisplatin)

Regimen #1

Study Evidence Comparator Efficacy
Fleming et al. 2004 (GOG 177) Phase III Cisplatin, Doxorubicin, Paclitaxel Seems to have inferior OS

Note: body surface area capped at 2.0 m2.

Chemotherapy

21-day cycle for 7 cycles

Regimen #2

Study Evidence Comparator Efficacy
Randall et al. 2006 (GOG 122) Phase III Whole abdominal irradiation Superior OS

Chemotherapy

Supportive hydration:

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

21-day cycle for 8 cycles

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, Doxorubicin, Paclitaxel

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

Regimen

Study Evidence Comparator Efficacy
Fleming et al. 2004 (GOG 177) Phase III Cisplatin & Doxorubicin Seems to have superior OS

Note: body surface area capped at 2.0 m2.

Chemotherapy

Supportive medications

21-day cycle for 7 cycles

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, Ifosfamide, Mesna (CIM)

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CIM: Cisplatin, Ifosfamide, Mesna

Regimen

Study Evidence Comparator Efficacy
Wolfson et al. 2007 (GOG 150) Phase III Whole abdominal irradiation Might have superior OS

Chemotherapy

Supportive medications

  • Mesna (Mesnex) 120 mg/m2 IV bolus over 15 minutes once on day 1, then 1500 mg/m2/day IV continuous infusion over 96 hours on days 1 to 4, given second together with Ifosfamide (Ifex)
  • Suggested hydration: 1 liter of NS or 1/2 NS given over several hours prior to chemotherapy

21-day cycle for 3 cycles

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 PMC article contains verified protocol PubMed

Cisplatin & Paclitaxel

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Regimen

Study Evidence
Dimopoulos et al. 2000 Phase II

Chemotherapy

Supportive medications

21-day cycle for up to 6 cycles

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)

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Regimen

Study Evidence
Moore et al. 1999 Phase II

Chemotherapy

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

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Regimen

Study Evidence Comparator Efficacy
Homesley et al. 2007 (GOG 161) Phase III Ifosfamide & Paclitaxel Seems to have inferior OS

Note: GOG 161 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.

Chemotherapy

Supportive medications

  • Mesna (Mesnex) 2000 mg IV over 12 hours once per day on days 1 to 3, starting 15 minutes before Ifosfamide (Ifex)
    • Alternate PO dosing: Mesna (Mesnex) 1330 mg PO taken three times per day, 1 hour before, 4 hours after, and 8 hours after Ifosfamide (Ifex) (4000 mg total dose per day), on days 1 to 3
  • Filgrastim (Neupogen) 5 mcg/kg SC once per day starting on day 4, to continue until ANC is greater than or equal to 2000

21-day cycle for 8 cycles

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

Ifosfamide & Paclitaxel

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Regimen

Study Evidence Comparator Efficacy
Homesley et al. 2007 (GOG 161) Phase III Ifosfamide Seems to have superior OS

Note: GOG 161 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.

Chemotherapy

Supportive medications

21-day cycle for 8 cycles

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)

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Regimen #1

Study Evidence
Lincoln et al. 2003 Phase II

Chemotherapy

Supportive medications

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

21-day cycles

Regimen #2

Study Evidence
Lissoni et al. 1996 Phase II

Chemotherapy

Supportive medications

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

21-day cycles

Regimen #3

Study Evidence
Ball et al. 1996 Phase II

Chemotherapy

  • Paclitaxel (Taxol) 250 mg/m2 IV continuous infusion over 24 hours once on day 1
    • Dosage for patients with previous pelvic radiation is 200 mg/m2 IV continuous infusion over 24 hours once on day 1
    • Dose can be changed to 200, 170, 135, 110 mg/m2 depending on toxicity

Supportive medications

  • Dexamethasone (Decadron) 20 mg PO/IV given twice, 12 and 6 hours prior to paclitaxel
  • Diphenhydramine (Benadryl) 50 mg PO/IV once 30 minutes prior to paclitaxel
  • Cimetidine (Tagamet) 300 mg IV once 30 minutes prior to paclitaxel
  • Filgrastim (Neupogen) 5 mcg/kg SC once per day 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

21-day cycles

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

Temsirolimus (Torisel)

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Regimen

Study Evidence
Oza et al. 2011 Phase II

Chemotherapy

28-day cycles, given until progression of disease, unacceptable toxicity, or patient decision

References

  1. Oza AM, Elit L, Tsao MS, Kamel-Reid S, Biagi J, Provencher DM, Gotlieb WH, Hoskins PJ, Ghatage P, Tonkin KS, Mackay HJ, Mazurka J, Sederias J, Ivy P, Dancey JE, Eisenhauer EA. Phase II study of temsirolimus in women with recurrent or metastatic endometrial cancer: a trial of the NCIC Clinical Trials Group. J Clin Oncol. 2011 Aug 20;29(24):3278-85. Epub 2011 Jul 25. link to original article contains verified protocol PubMed

Topotecan (Hycamtin)

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Regimen

Study Evidence
Wadler et al. 2003 (ECOG E3E93) Phase II

Chemotherapy

  • Topotecan (Hycamtin) 1.5 mg/m2 IV once per day on days 1 to 5
    • Dosage for patients with previous pelvic radiation is 1.2 mg/m2, which can be increased 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

Whole abdominal radiation (WAI)

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Regimen

Study Evidence Comparator Efficacy
Randall et al. 2006 (GOG 122) Phase III Cisplatin & Doxorubicin Inferior OS
Wolfson et al. 2007 (GOG 150) Phase III CIM Might have inferior OS

Not commonly used but was a comparator arm; here for reference purposes only.

References

  1. 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
  2. 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 PMC article contains verified protocol PubMed