Treatment of uterine papillary serous carcinoma

Abstract

Introduction: This review focuses on both current and forthcoming therapeutics in the management of uterine serous carcinoma (USC).Areas covered: A search for all research articles published in the English language from 1 January 1996 to 30 June 2013 was made in MEDLINE using the terms ‘endometrial cancer', ‘uterine cancer', ‘uterine papillary serous carcinoma' and ‘uterine serous carcinoma'. USC is a disease characterized by high recurrence rates and poor prognosis. Both radiation therapy and chemotherapy have been added postoperatively in an effort to improve outcomes. Platinum/taxane-based chemotherapy appears to improve survival outcomes for women with early or advanced stage disease. In the past decade, identification of several genes involved in USC pathogenesis, including human epidermal growth factor receptor 2, have led to targeted drug development against this tumor. Moreover, the advent of whole-genome sequencing has heralded a new frontier in understanding the molecular and genetic drivers of tumorigenesis in USC.Expert opinion: For women with residual uterine disease at the time of primary surgery, adjuvant therapy with carboplatin and paclitaxel, with or without tumor volume directed radiation therapy, has been shown to improve survival outcomes. Women with advanced stage or recurrent disease should undergo an attempt at an optimal cytoreductive surgery for no visible residual disease whenever possible, followed by consideration of platinum and taxane-based chemotherapy in conjunction with radiation therapy. Prospective trials combining traditional therapeutics with novel targeted biological therapies are active and enrolling, and the authors hope that these will help us to better optimize the care and survival of women with this lethal gynecologic malignancy.