Improving response to progestin treatment of low-grade endometrial cancer
| Autor: | Andreas Obermair, Frédéric Amant, Michael A. Quinn, Shannon N. Westin, Camilla Krakstad, Jennifer J. Mueller, Jessica N. McAlpine, Donal J. Brennan, Mignon D. J. M. van Gent, Robert L. Coleman, David G. Huntsman, Melinda S. Yates, Monika Janda, Eva Baxter |
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| Rok vydání: | 2020 |
| Předmět: |
Oncology
medicine.medical_specialty endometrial neoplasms MICROSATELLITE INSTABILITY medicine.drug_class Cochrane Library 03 medical and health sciences 0302 clinical medicine Internal medicine PROGNOSTIC-SIGNIFICANCE medicine FERTILITY-SPARING-MANAGEMENT Stage (cooking) COMPLEX ATYPICAL HYPERPLASIA BARIATRIC SURGERY Predictive biomarker Science & Technology 030219 obstetrics & reproductive medicine business.industry Endometrial cancer REPRODUCTIVE OUTCOMES Obstetrics & Gynecology Obstetrics and Gynecology NONSTEROIDAL ANTIINFLAMMATORY DRUGS YOUNG-WOMEN medicine.disease MEDROXYPROGESTERONE ACETATE Endometrial hyperplasia BODY-MASS INDEX Estrogen 030220 oncology & carcinogenesis business Life Sciences & Biomedicine endometrial hyperplasia Progestin Body mass index |
| Zdroj: | International Journal of Gynecological Cancer |
| ISSN: | 1525-1438 1048-891X 1811-1823 |
| DOI: | 10.1136/ijgc-2020-001309 |
| Popis: | ObjectivesThis review examines how response rates to progestin treatment of low-grade endometrial cancer can be improved. In addition to providing a brief overview of the pathogenesis of low-grade endometrial cancer, we discuss limitations in the current classification of endometrial cancer and how stratification may be refined using molecular markers to reproducibly identify ‘low-risk’ cancers which may represent the best candidates for progestin therapy. We also discuss constraints in current approaches to progestin treatment of low-grade endometrial cancer and perform a systematic review of predictive biomarkers.MethodsPubMed, ClinicalTrials.gov, and Cochrane Library were searched for studies reporting pre-treatment biomarkers associated with outcome in women with low-grade endometrial cancer or endometrial hyperplasia with an intact uterus who received progestin treatment. Studies of fewer than 50 women were excluded. The study protocol was registered in PROSPERO (ID 152374). A descriptive synthesis of pre-treatment predictive biomarkers reported in the included studies was conducted.ResultsOf 1908 records reviewed, 19 studies were included. Clinical features such as age or body mass index cannot predict progestin response. Lesions defined as ‘low-risk’ by FIGO criteria (stage 1A, grade 1) can respond well; however, the reproducibility and prognostic ability of the current histopathological classification system is suboptimal. Molecular markers can be reproducibly assessed, have been validated as prognostic biomarkers, and may inform patient selection for progestin treatment. DNA polymerase epsilon (POLE)-ultramutated tumors and a subset of p53 wild-type or DNA mismatch repair (MMR)-deficient tumors with ‘low-risk’ features (eg, progesterone and estrogen receptor-positive) may have improved response rates, though this needs to be validated.DiscussionMolecular markers can identify cases which may be candidates for progestin treatment. More work is needed to validate these biomarkers and potentially identify new ones. Predictive biomarkers are anticipated to inform future research into progestin treatment of low-grade endometrial cancer and ultimately improve patient outcomes. |
| Databáze: | OpenAIRE |
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