Patterns of chemotherapy use in women with recurrent endometrial cancer (582)

Abstract

Objectives: Recurrent endometrial cancer has a poor prognosis. The optimal treatment regimen in this setting remains unclear. The objective of this study was to describe patterns of utilization of cytotoxic, hormonal, and immunotherapy in women with endometrial cancer in the adjuvant setting and at the time of the first recurrence. Methods: A retrospective cohort study using the IBM MarketScan database was performed. We identified commercially insured women with endometrial cancer who underwent hysterectomy between 2011 and 2019, with or without adjuvant treatment. The use of clinically relevant therapeutic agents and those that were utilized in >2% of the cohort, as well as combination regimens, were determined in the adjuvant setting and at the time of the first recurrence. Recurrence was defined based on the introduction of a new agent or a gap of greater than three months from adjuvant therapy, or based on the initiation of chemotherapy more than 180 days after hysterectomy, for patients who did and did not receive adjuvant chemotherapy, respectively. Results: A total of 21,327 patients were identified. Of these, 6,828 (32.0%) received adjuvant radiation therapy, and 4,189 (19.6%) received adjuvant chemotherapy (78.2% of whom also received radiation). Of those who received adjuvant chemotherapy, the most commonly utilized agents were carboplatin (90.5%), paclitaxel (85.8%), cisplatin (9.4%), docetaxel (9.3%), gemcitabine (3.8%), and doxorubicin (2.1%), while bevacizumab was utilized in 1.5% of patients. A combination of platinum and a taxane was utilized as adjuvant therapy in 88.9% of women. Therapy for recurrent endometrial cancer was initiated in 1,707 patients (8.0% of the entire cohort). The median time from hysterectomy to initiation of chemotherapy for recurrence was 13.3 months (IQR: 7.6 to 23.0 months). Overall, platinum and taxane combination therapy was used in 747 (49.2%) patients, platinum alone or with other drugs in 186 (12.2%), and taxanes alone or with other drugs in 135 (8.9%). Non-platinum/non- taxane cytotoxic therapy was started in 236 (15.5%) patients, while 130 (8.6%) were treated with hormonal therapy and 24 (1.6%) with immunotherapy. While most patients who had not received adjuvant therapy also received platinum-based therapy, they were more likely than those who received adjuvant therapy to receive non-platinum- based regimens and hormonal therapy. Conclusions: Among women with endometrial cancer who underwent a hysterectomy, platinum-taxane combination chemotherapy was used in almost 90% of patients as adjuvant therapy while nearly 70% of women were treated with platinum or taxane-based therapy at first recurrence. Objectives: Recurrent endometrial cancer has a poor prognosis. The optimal treatment regimen in this setting remains unclear. The objective of this study was to describe patterns of utilization of cytotoxic, hormonal, and immunotherapy in women with endometrial cancer in the adjuvant setting and at the time of the first recurrence. Methods: A retrospective cohort study using the IBM MarketScan database was performed. We identified commercially insured women with endometrial cancer who underwent hysterectomy between 2011 and 2019, with or without adjuvant treatment. The use of clinically relevant therapeutic agents and those that were utilized in >2% of the cohort, as well as combination regimens, were determined in the adjuvant setting and at the time of the first recurrence. Recurrence was defined based on the introduction of a new agent or a gap of greater than three months from adjuvant therapy, or based on the initiation of chemotherapy more than 180 days after hysterectomy, for patients who did and did not receive adjuvant chemotherapy, respectively. Results: A total of 21,327 patients were identified. Of these, 6,828 (32.0%) received adjuvant radiation therapy, and 4,189 (19.6%) received adjuvant chemotherapy (78.2% of whom also received radiation). Of those who received adjuvant chemotherapy, the most commonly utilized agents were carboplatin (90.5%), paclitaxel (85.8%), cisplatin (9.4%), docetaxel (9.3%), gemcitabine (3.8%), and doxorubicin (2.1%), while bevacizumab was utilized in 1.5% of patients. A combination of platinum and a taxane was utilized as adjuvant therapy in 88.9% of women. Therapy for recurrent endometrial cancer was initiated in 1,707 patients (8.0% of the entire cohort). The median time from hysterectomy to initiation of chemotherapy for recurrence was 13.3 months (IQR: 7.6 to 23.0 months). Overall, platinum and taxane combination therapy was used in 747 (49.2%) patients, platinum alone or with other drugs in 186 (12.2%), and taxanes alone or with other drugs in 135 (8.9%). Non-platinum/non- taxane cytotoxic therapy was started in 236 (15.5%) patients, while 130 (8.6%) were treated with hormonal therapy and 24 (1.6%) with immunotherapy. While most patients who had not received adjuvant therapy also received platinum-based therapy, they were more likely than those who received adjuvant therapy to receive non-platinum- based regimens and hormonal therapy. Conclusions: Among women with endometrial cancer who underwent a hysterectomy, platinum-taxane combination chemotherapy was used in almost 90% of patients as adjuvant therapy while nearly 70% of women were treated with platinum or taxane-based therapy at first recurrence.