New Horizons for Patients with Endometrial Cancer

September is Uterine Cancer Awareness Month. Raising awareness is very close to the MVisionaries since uterine cancer is the fourth most common cancer for women. It is estimated that 66,570 people in the United States alone will be diagnosed with uterine cancer this year. 90% of uterine cancers are endometrioid adenocarcinoma (or endometrial cancer).

With this in mind, doctors and scientists are working very hard to bring innovative treatment solutions and ideas to uterine cancer. The University Hospital Cologne has been at the forefront of innovation for radiotherapy. Director of University Hospital Cologne, Prof. Dr. Simone Marnitz, researches radiotherapy, brachytherapy, chemotherapy, and gynaecological cancer.

Dr. Marnitz provides in depth insight into the state of endometrial cancer

As stated by Dr. Marnitz, the classic classification into type I (estrogen-dependent) and type II (estrogen-independent) as well as clinical factors (age, myometrium infiltration, grading, tumor size, lymphovascular space involvement) do not adequately reflect the biology of the disease and the prognosis of the individual patient.

We understood that the inadequate patient selection for the large randomized studies on this very clinical basis led to more or less inconclusive results due to a lack of better knowledge and therefore offered no clear evidence for our clinical action [1-3].

The big questions with endometrial cancer – who needs adjuvant radiotherapy and which ones, who benefits from chemotherapy, which patients need chemo-radiation, – will be decided by genomics. Therefore, over- and under treatment can be avoided [4, 5].

At first glance, the following new ones have become established:

• the presence of the P53 mutation is associated with a clearly unfavorable prognosis,
• the presence of the POLE mutation with a favorable prognosis, even with locally advanced findings, is associated with a very good clinical outcome,
• Intermediate courses are described for an unspecified molecular profile (NSMP) and for microsatellite instability (MSI) [6] .

The insights into individual tumor genomics triggered a revolution in oncological therapy decisions [7]. With the new European Guideline we provide a new classification for prognosis, prediction and treatment decision [8]. Now we can offer individual treatment decisions and avoid unnecessary toxicity from chemotherapy and radiation for a substantial number of endometrial cancer patients and escalate adjuvant treatment in a small group of patients with unfavourable genomic characteristics. Clinical trials are on the way to validate the new classification system [9].

Guideline-Compliant Female Pelvis Model 

We are proud to provide the only guideline-compliant female pelvis model for various gynaecological cancers, including endometrial cancer. We have a standard and advanced model, targeting 16 OARs. Both follow multiple consensus guidelines, including ESTRO and RTOG.

Learn more about incorporating guideline-compliant radiotherapy services into your clinic with MVision AI: 

c/o Terkko Health Hub, Haartmaninkatu 4, 00290 Helsinki, Finland.

Tel: +358 (0) 40 5489 229

Website: https://www.mvision.ai 

Email: info@mvision.ai 

Social Media: Facebook, Instagram, LinkedIn, Twitter, and Youtube

For media inquiries:

Tel: +358 40 500 7915

Email: pr@mvision.ai

Sources

1. Randall ME, Filiaci V, McMeekin DS, von Gruenigen V, Huang H, Yashar CM, Mannel RS, Kim JW, Salani R, DiSilvestro PA et al: Phase III Trial: Adjuvant Pelvic Radiation Therapy Versus Vaginal Brachytherapy Plus Paclitaxel/Carboplatin in High-Intermediate and High-Risk Early Stage Endometrial Cancer. J Clin Oncol 2019, 37(21):1810-1818.
2. Matei D, Filiaci V, Randall ME, Mutch D, Steinhoff MM, DiSilvestro PA, Moxley KM, Kim YM, Powell MA, O’Malley DM et al: Adjuvant Chemotherapy plus Radiation for Locally Advanced Endometrial Cancer. The New England journal of medicine 2019, 380(24):2317-2326.
3. de Boer SM, Powell ME, Mileshkin L, Katsaros D, Bessette P, Haie-Meder C, Ottevanger PB, Ledermann JA, Khaw P, Colombo A et al: Adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): final results of an international, open-label, multicentre, randomised, phase 3 trial. The Lancet Oncology 2018, 19(3):295-309.
4. Marnitz S, Schomig-Markiefka B: [The PORTEC-3 trial for high-risk endometrial cancer: impact of molecular classification on prognosis and benefit from adjuvant therapy]. Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft  [et al] 2021, 197(3):266-268.
5. Marnitz S, Waltar T, Kohler C, Mustea A, Schomig-Markiefka B: The brave new world of endometrial cancer : Future implications for adjuvant treatment decisions. Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft  [et al] 2020, 196(11):963-972.
6. Wortman BG, Bosse T, Nout RA, Lutgens L, van der Steen-Banasik EM, Westerveld H, van den Berg H, Slot A, De Winter KAJ, Verhoeven-Adema KW et al: Molecular-integrated risk profile to determine adjuvant radiotherapy in endometrial cancer: Evaluation of the pilot phase of the PORTEC-4a trial. Gynecol Oncol 2018, 151(1):69-75.
7. Cancer Genome Atlas Research N, Kandoth C, Schultz N, Cherniack AD, Akbani R, Liu Y, Shen H, Robertson AG, Pashtan I, Shen R et al: Integrated genomic characterization of endometrial carcinoma. Nature 2013, 497(7447):67-73.
8. Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, Ledermann J, Bosse T, Chargari C, Fagotti A et al: ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer 2021, 31(1):12-39.
9. de Boer S, Powell M, Mileshkin L, al. e: Clinical trial information: NCT00411138. PORTEC 3 Study. ASCO 2017 Abstract  5502.