How to treat uterine cancer?

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Uterine cancer

According to the latest report from the US Centers for Disease Control and Prevention (CDC), the incidence of almost all cancers has declined in the past two decades, while the incidence of uterine cancer has risen. Doctors began to pay attention to this situation and reminded women to pay attention to several key issues of this disease.

Types of uterine cancer

Uterine cancer refers to any cancer that starts in the uterus. According to statistics from the American Cancer Society (ACS), more than 90% of uterine cancers occur in the endometrium, called endometrial cancer.

Another type of uterine cancer is uterine sarcoma. This type of cancer is formed in the muscles and connective tissue of the uterus and is less common-only about 4% of all cases of uterine cancer.

Risk factors for uterine cancer

From 1999 to 2016, the incidence of new uterine cancer increased by 0.7% annually, an increase of 12% over the study period. The mortality rate has also increased by 1.1% annually, or an overall increase of 21%, almost doubling. The main risk factors are:

Caucasian and black women have significantly higher risks than Asians and Hispanics

Obese women who are overweight or obese are two to four times more likely to develop endometrial cancer than women of healthy weight. (Adipose tissue produces abnormal levels of estrogen, which stimulates hormone-sensitive cancer.)

Women after 55 years of age are most at risk. Premenopausal women usually do not develop endometrial cancer, which is why most women are diagnosed in stage 1-because these women have already gone through menopause, when they start to have pink discharge or Abnormal bleeding will cause attention.

Irregular menstrual periods can lead to excessive estrogen circulation in the body, causing the cells in the uterus to lose control.

Types of uterine cancer

Uterine cancer refers to any cancer that starts in the uterus. According to statistics from the American Cancer Society (ACS), more than 90% of uterine cancers occur in the endometrium, called endometrial cancer.

Another type of uterine cancer is uterine sarcoma. This type of cancer is formed in the muscles and connective tissue of the uterus and is less common-only about 4% of all cases of uterine cancer.

 

Diagnosis and prognosis of uterine cancer

Most uterine cancers have a good prognosis. According to the US Centers for Disease Control and Prevention, the estimated five-year relative survival rate is 80% to 90%. Because uterine cancer can usually be diagnosed early, its most typical symptoms are abnormal bleeding before and after menopause, weight loss and pelvic pain.

Birth control pills and hormone IUDs contain progesterone, which can counteract excess estrogen in the body.

One of the largest and longest-term studies published in the American Journal of Obstetrics and Gynecology in 2017 found that the risk of taking birth control pills and endometrial cancer was reduced by approximately 33%. This is also related to reducing the risk of ovarian and colorectal cancer.

Treatment options for uterine cancer

Surgery for uterine cancer

Surgery is usually the main treatment for endometrial cancer, including hysterectomy, usually accompanied by fallopian tube ovectomy and lymph node dissection. In some cases, pelvic washing, omentum removal, and / or peritoneal biopsy are performed. If the cancer has spread to the entire pelvis and abdomen (abdomen), tumor reduction surgery (removing as much cancer as possible) can be performed.

Radiotherapy for uterine cancer

Radiation therapy uses high-energy radiation (such as X-rays) to kill cancer cells. It can treat endometrial cancer in two ways:

Put radioactive material into the body. This is called internal radiation therapy or brachytherapy.

By using X-ray radiotherapy equipment such as radiographic knife, linear accelerator, Tomo knife, etc., if economic conditions permit, you can also choose more accurate proton radiotherapy with fewer side effects. 7998).

Chemotherapy

Chemotherapy (chemo) is the use of drugs to kill cancer cells. Treatment is intravenous or oral. Follow the blood and enter the whole body. Therefore, when endometrial cancer has spread beyond the endometrium and surgery is not possible, chemotherapy is the main treatment.

Chemotherapy drugs currently used to treat endometrial cancer:

· Paclitaxel (Taxol®)

· Carboplatin

· Doxorubicin or liposomal doxorubicin

· Cisplatin

· Docetaxel

If it is a sarcoma, ifosfamide (IFEX ®) is usually used as a single agent or with cisplatin or paclitaxel. Targeted drug trastuzumab (Herceptin®) can be added for HER2-positive uterine sarcoma. (HER2 is a protein that can help some cancer cells grow and spread faster.)

Hormone therapy

It is most commonly used to treat advanced (stage III or IV) or relapsed endometrial cancer and is usually used with chemotherapy. Hormonal therapy includes:

· Progesterone (This is the main hormone therapy used.)

· Tamoxifen

· Luteinizing hormone-releasing hormone agonist (LHRH agonist)

· Aromatase inhibitors (AIs)

At present, no hormone therapy has been found to be the best for endometrial cancer.

Targeted therapy

At present, only a few targeted therapy can be used for endometrial cancer, mainly for the treatment of malignant endometrial cancer and metastasis or recurrence.

Bevacizumab

Bevacizumab (Avastin®) is an angiogenesis inhibitor. Cancer growth and spread requires the creation of new blood vessels to nourish themselves (the process of angiogenesis). The drug attaches to a protein called VEGF (indicating the formation of new blood vessels) and slows or prevents the growth of cancer.

Bevacizumab is usually given with chemotherapy, or it can be given alone. Give intravenously every 2 to 3 weeks.

mTOR inhibitor

These drugs block mTOR cell proteins, which usually help cells grow and divide into new cells. It can be administered alone or with chemotherapy or hormone therapy to treat advanced or recurrent endometrial cancer. Currently approved are everolimus (Afinitor®) and tansimolimus (TORISEL®).

The latest development of uterine cancer

  1. Avelumab (Bavincia monoclonal antibody) combined with talazoparib (tarazopanib)

A trial led by Konstantinopoulos used the immune checkpoint inhibitor avelumab in combination with the PARP inhibitor talazoparib. (Checkpoint inhibitors clear the way for the immune system to attack cancer; PARP inhibitors destroy cancer cells by hindering their ability to repair damaged DNA.) In a previous experiment, avelumab was Patients with “unstable” endometrial cancer are very effective, but are essentially inactive in the more common “microsatellite st
able” (MSS) form of the disease. The trial will explore whether combining avelumab with PARP inhibitors is more effective in patients with MSS disease.

2. Pembrolizumab (pabolizumab) combined with mirvetuximab

A test combining the checkpoint inhibitor pembrolizumab with mirvetuximab. (Pembrolizumab targets an immune checkpoint protein called PD-1; mirvetuximab adds antibodies to drug molecules that target key structures in rapidly dividing cancer cells.) The trial, led by Jennifer Veneris, MD, of the Gynecologic Oncology Project, will examine the combination Effectiveness in patients with MSS endometrial cancer.

3. abemaciclib + LY3023414 + hormone therapy

Another trial led by Konstantinopoulos will test the combination of targeted drug abemaciclib + LY3023414 + hormone therapy. (LY3023414 targets a cancer cell enzyme called PI 3 kinase; abemaciclib interferes with a critical stage of the cell cycle.) 70% to 90% of endometrial cancers are fed by estrogen, initially responding to hormone blocking therapy, but ultimately relapse. By adding abemaciclib and LY3023414 (they can touch two parts of the same molecular pathway) for hormone blocking therapy, the researchers hope to overcome the drug resistance problem.

4. AZD1775

A trial led by Joyce Liu, MD, PHD, Director of Clinical Research, Dana-Farber Gynecologic Oncology, used AZD1775 for patients with high-grade serous uterine cancer that accounted for 10-15% of endometrial cancer. Such cancers are aggressive and usually recur after standard treatment. The recently opened trial is based on a study led by Dr. Liu and Ursula Matulonis, director of the Dana-Farber Department of Gynecologic Oncology, showing that AZD1775 is active in a patient model with high-grade serous ovarian cancer.

5. dostarlimab (TSR-042)

The results of the Phase I / II GARNET trial were recently published, and the overall effective rate of PD-1 inhibitor dostarlimab (TSR-042) for patients with relapsed or advanced endometrial cancer is close to 30%.

In addition, both microsatellite high instability (MSI-H) and microsatellite stability (MSS) groups are persistent.

Dostarlimab (TSR-042) is a humanized anti-PD-1 monoclonal antibody jointly developed by TESARO and AnaptysBio. It binds to the PD-1 receptor with high affinity, thereby blocking its binding to PD-L1 and PD-L2 ligands.

The results showed that the effective rate of the entire population was 29.6%, the effective rate of the MSI-H patient group was 48.8%, and the effective rate in the MSS cohort was 20.3%. Six patients (2 MSI-H and 4 MSS) had complete remission.

After a median follow-up of 10 months, 89% of patients received treatment> 6 months, and 49% of patients received treatment for> 1 year. In addition, 84% of patients with effective treatment are still receiving treatment.

Finally, in 85% of MSI-H responders, the total tumor burden decreased by ≥50%, and 69% of patients with MSS had a total tumor burden reduction of ≥50%.

Dostarlimab is a new hope for the treatment of endometrial cancer and may replace pembrolizumab, because pembrolizumab only works well in patients with MSI-H, and Dostarlimab does not need to be considered.

The researchers will start further III studies in the second half of 2019. Dostarlimab and chemotherapy will be combined with first-line treatment of endometrial cancer. We look forward to obtaining promising results soon!

Each trial addresses the shortcomings of standard treatment or problems found in previous new drug trials. For example, the first two trials are aimed at overcoming the current state of poor immunotherapy in patients with MSS disease. The third solves the problem of resistance to hormone therapy, and the fourth targets specific subtypes of endothelial cancer.

More on the latest research progress and the best medication plan for lung cancer, only the top cancer experts at home and abroad have rich clinical experience. You can apply for consultation with authoritative experts through the Global Oncologist Network to obtain the best diagnosis and treatment plan.

Most uterine cancers have a good prognosis. According to the US Centers for Disease Control and Prevention, the estimated five-year relative survival rate is 80% to 90%. Because uterine cancer can usually be diagnosed early, its most typical symptoms are abnormal bleeding before and after menopause, weight loss and pelvic pain.

Birth control pills and hormone IUDs contain progesterone, which can counteract excess estrogen in the body.

One of the largest and longest-term studies published in the American Journal of Obstetrics and Gynecology in 2017 found that the risk of taking birth control pills and endometrial cancer was reduced by approximately 33%. This is also related to reducing the risk of ovarian and colorectal cancer.

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