Treatment options for endometrial cancer: experience with topotecan

Although the prognosis for women with endometrial cancer confined to the uterus is relatively good, with a 5-year survival of approximately 90%, women with advanced or recurrent disease have a much poorer outcome. Systemic hormonal therapy with progestins improves survival in progesterone-receptor-positive tumors but chemotherapy is indicated as front-line therapy for most patients with this disease. Few single chemotherapy agents achieve response rates greater than 20%. The combination of doxorubicin and cisplatin is the first-line treatment of choice but the response and survival rates are still low compared to ovarian cancer treatments and more active regimens are needed. Treatment options for second-line chemotherapy are even more limited because of low response rates and toxicity issues related to prior radiation therapy. The topoisomerase I inhibitor, topotecan, is being investigated for the treatment of endometrial cancer. In previously treated patients, single-agent topotecan achieved a response in 10% of patients and disease stabilized in 55% of patients. The combination of topotecan and cisplatin is being studied in chemotherapy-naive elderly patients. Topotecan is also active in uterine papillary serous carcinoma, an aggressive form of the disease that generally does not respond to chemotherapy.