Evolving treatment landscape of advanced endometrial cancer – A current perspective from a German tertiary referral center for gynecological oncology

Abstract

Endometrial cancer (EC) represents the most prevalent cancer of the female genital tract worldwide. Although EC has an overall good prognosis compared to other gynecological malignancies, a recent report from the American Cancer Society indicated that the cancer-specific survival of patients with EC has decreased since the 1970s, while the incidence has remained stable ( [1] Siegel R.L. Miller K.D. Fuchs H.E. Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022 Jan; 72: 7-33 Google Scholar ). The increasing EC-specific mortality is particularly attributable to EC with non-endometrioid histology. Although non-endometrioid histology represents only about 20% of all EC, non-endometrioid EC account for more than half of EC-related deaths ( 2 Clarke M.A. Devesa S.S. Harvey S.V. Wentzensen N. Hysterectomy-Corrected Uterine Corpus Cancer Incidence Trends and Differences in Relative Survival Reveal Racial Disparities and Rising Rates of Nonendometrioid Cancers. J Clin Oncol Off J Am Soc Clin Oncol. 2019 Aug 1; 37: 1895-1908 Google Scholar , 3 McGunigal M. Liu J. Kalir T. Chadha M. Gupta V. Survival Differences Among Uterine Papillary Serous, Clear Cell and Grade 3 Endometrioid Adenocarcinoma Endometrial Cancers: A National Cancer Database Analysis. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2017 Jan; 27: 85-92 Google Scholar ). The determinants underlying the increase in non-endometrioid EC remain elusive. Overall, EC contrasts to the majority of other malignancies, whose cancer-specific survival has improved in recent years ( [1] Siegel R.L. Miller K.D. Fuchs H.E. Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022 Jan; 72: 7-33 Google Scholar ). Hence, it is crucial to reconsider and optimize existing therapy strategies and, to incorporate novel scientific findings into therapy algorithms. Here, we compile existing therapeutic concepts for advanced EC and propose a treatment algorithm based on current clinical and translational research findings.