Cytotoxic chemotherapy for patients with endometrial carcinoma

Endometrial carcinoma is now the most common gynecologic cancer in the United States and its incidence is increasing. Many investigators attribute this to exogenous factors over which little control has been exerted in the western world. Obesity, dietary fat content, and changing patterns of parity and lifestyle seem significant. Moreover, there appears to be an emerging virulence noted, particularly in some centers. Improved surgical staging and a better understanding of virulence factors will increase the number of patients requiring treatment to fields larger than heretofore recognized. We can expect that one third of the patients with endometrial cancer will require treatment for widespread disease or recurrent disease. Progestational treatment is useful in approximately one-third of all patients with recurrent disease. Thus, systemic nonhormonal chemotherapy must be developed if cure rates in this disease are to improve appreciably. In 1974, only 126 patients had been reported to have been treated with cytotoxic chemotherapy for endometrial cancer. Since that time, experience has demonstrated that the most active single agents are adriamycin, cisplatin, and hexamethylmelamine. These drugs produce a 30-40% response rate when used individually. Multidrug regimens employing various combinations have achieved responses of 15-85% with and without the inclusion of a progestational agent. The median duration of response has been increased but cures are still relatively few. Adverse effects are tolerable and age is not a contraindication to the administration of cytotoxic chemotherapy. Adjuvant treatment is being tested and optimism for future success is justified.