Changes to Endometrial Cancer Treatment with Daniela Matei, MD
Results from a randomized phase 3 clinical trial, published in The New England Journal of Medicine, could change the way women are treated for later stage endometrial cancer. Northwestern’s Daniela Matei, MD, explains.
"The results of these studies support that chemotherapy alone should remain the standard of care for stage 3 uterine cancer."
— Daniela Matei, MD
- Diana, Princess of Wales Professor of Cancer Research
- Professor of Medicine in the Division of Hematology and Oncology
- Professor of Obstetrics and Gynecology in the Division of Gynecologic Oncology
- Co-leader of the Translational Research in Solid Tumors Program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University
- Gynecologic Oncologist, Northwestern Medicine
Endometrial cancer is the most common of gynecologic cancers: More than 62,000 cases are diagnosed per year. A woman's lifetime risk for developing endometrial cancer is about 3 percent. At the same time, mortality from endometrial cancer has also been going up by about 1.6 percent a year in the United States.
Patients are typically treated with chemotherapy, and those with stage 3/4A, at higher risk of reoccurrence, are also given radiation. A new study led by Daniela Matei, MD, (GOG-258 trial) published in The New England Journal of Medicine, found that radiation plus chemotherapy doesn’t improve endometrial cancer recurrence-free survival and that chemotherapy alone should be the standard treatment for these women.
Daniela Matei: "This will be a difficult change because radiation has been used historically in this group of patients and clearly has a role reducing the rates of local pelvic recurrence. Even here in this study we show that patients who were randomized to the combined modality treatment had lower five-year incidents of a vaginal pelvic and paraaortic lymph node reoccurrence compared to those patients who receive chemotherapy alone. However, these patients eventually will succumb disease because of their high risk for systemic outside of pelvis failure. And for this risk chemotherapy, alone is clearly beneficial and should remain the mainstay of treatment."
The phase 3 trial randomly assigned 736 eligible patients to one of two possible treatment arms. A group of 346 received a combined treatment consisting of chemotherapy and radiation over 21 weeks, a second group of 361 women received chemotherapy alone over 17 weeks.
A median follow-up six months after the randomized phase 3 trial showed the recurrence-free survival for the two arms of the trial were very similar: 59 percent for the group that got chemotherapy and radiation and 58 percent for chemotherapy alone.
A change in treatment will benefit the rising number of women diagnosed with endometrial cancer, as they will not need to be exposed to radiation treatment. And Matei expects the number of cases to continue to rise and says the obesity epidemic could be the cause.
Daniela Matei: "More than half of cases of endometrial cancer in the United States are in fact thought to be attributable to being overweight and obese. There is actually a kind of a response relationship with the more obese you are, the higher the risk for endometrial cancer."
Biologically, the visceral fat, which is composed of adipocytes and preadipocytes, is thought to secrete a number adipocytes factors that stimulate both a state of chronic inflammation, Matei says. These are also factors that stimulate the proliferation of endometrial cells, she added.
Daniela Matei: "Also, we know that obesity is linked to the risk of diabetes and high levels of glucose, high levels of insulin and insulin growth factor have been shown in preclinical models to be stimulators for endometrial cancer proliferation."
The median age of women diagnosed is 60, and while there is no screening tool, it is often caught early because its symptoms are very noticeable.
Daniela Matei: "Any woman who would experience postmenopausal bleeding should be evaluated immediately. And that is unlike an ovarian cancer where symptoms don't develop early."
Matei is passionate about her work in treating women with a variety of gynecologic cancers. She often turns to poetry as an outlet to talk about her work. Here she reads one of her poems, Bloom:
I dressed up in my new tight
perfectly tailored brooks brothers skirt
I put on mademoiselle perfume
blue shadow around my eyes
tan peep-toe heels before
I kept my smile the misty pleasant scent
throughout the day I did not flinch
sharing my compassion
endlessly I shook
hands patted shoulders
I did not feel pain until
when I walked out spring
was finally here
the balmy wind
blossoms on every tree
cancer is pink
Continuing Medical Education Credit
Physicians who listen to this podcast may claim continuing medical education credit after listening to an episode of this program.
Academic/Research, Multiple specialties
At the conclusion of this activity, participants will be able to:
- Identify the research interests and initiatives of Feinberg faculty.
- Discuss new updates in clinical and translational research.
The Northwestern University Feinberg School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit Designation Statement
The Northwestern University Feinberg School of Medicine designates this Enduring Material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Daniela Matei, MD, disclosed external professional relationships (consulting) with AstraZeneca and Genentech, Inc. Peer Reviewer, Serdar Bulun, MD, has nothing to disclose. Course director, Robert Rosa, MD, has nothing to disclose. Planning committee member, Erin Spain, has nothing to disclose. Feinberg School of Medicine's CME Leadership and Staff have nothing to disclose: Clara J. Schroedl, MD, Medical Director of CME, Sheryl Corey, Manager of CME, Jennifer Banys, Senior Program Administrator, Allison McCollum, Senior Program Coordinator, and Rhea Alexis Banks, Administrative Assistant 2.