Targeted treatments in endometrial cancer

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Published: 14 Oct 2011
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Dr Helga Salvesen – Haukeland University Hospital, Bergen, Norway
Dr Helga Salvesen talks about the need for endometrial cancer research as it is the most common gynaecological malignancy, but has significantly fewer trials and collected data than that of ovarian and breast cancer despite being so common.

The current treatment is a surgical course after diagnosis and then to classify the patient as high or low risk. From there high risk patients are usually given chemotherapy, with some rare sub groups given radiotherapy. Recent findings have identified promising targets; biomarkers that can identify high and low risk patients, which would allow for high risk patients to receive full treatment including systemic therapy and avoid the overtreatment of low risk patients.

17th International Meeting of the European Society of Gynaecological Oncology (ESGO 2011) 11—14 September 2011, Milan, Italy

Targeted treatments in endometrial cancer

Dr Helga Salvesen – Haukeland University Hospital, Bergen, Norway

Endometrial cancer is an under-researched disease. Thinking about the fact that endometrial cancer today is the most common gynaecologic malignancy and if you’re searching you find more than 1,500 hits for ovarian cancers, compared to less than 400 for endometrial cancer. So it is under-researched compared to ovarian cancer. Still we know quite a bit about potential molecular targets; endometrial cancer seems to be less heterogeneous, as compared to ovarian cancer. We have this big group of endometrial cancers which have certain molecular characteristics, it seems like.

Can these molecular targets be used to individualise therapies?

I think they can be used to individualise therapy in two ways. You can use the biomarkers to define high and low risk patients with greater certainty. In that way you would be able to give full treatment, including systemic therapy, to the high risk patients and you can, at the same time, avoid over-treatment of the low risk patients and then also side effects. When it comes to developing new drugs there are no targeted therapies presently available for regular clinical use in endometrial cancer and in that regard we are behind breast and colorectal cancers, for instance. There are targets that have been defined that have promising results from molecular studies, in particular it may be promising to target FGFR2 mutated tumour samples and tumour samples with activation of PI3 kinase signalling pathway. Drugs targeting PI3 kinase signalling, mTOR signalling, drugs from those types of medicines are presently in phase I and II trials.

What is the current treatment for endometrial cancer?

Presently you do surgical treatment when the patient is diagnosed, then you try to classify them as high or low risk patients to develop recurrent disease and basically adjuvant therapy is to give chemotherapy to high risk patients. You also have radiotherapy that is given to some sub-groups of endometrial cancer patients also defined as high risk patients.

Is fertility preservation considered in treatment with this type of cancer?

Not really but it has to be considered experimental. Endometrial cancer incidence is supposed to be associated with obesity so when we have more obese women, more young women will also develop endometrial cancer and that makes, of course, fertility preserving treatment more relevant for this group as well. But we have no solid data yet but it’s more an experimental thing that has been tried.