Rating the Chemotherapy Options for Advanced Uterine Adenocarcinoma

During 1996 it is estimated that 34,000 women will develop endometrial adenocarcinoma, and 5900 will succumb to the disease. However, in nearly 75% of patients the diagnosis is made early, when the disease is confined to the uterus and easily treated with surgery. Approximately 25% of patients will have operative findings that make them appropriate candidates for postoperative adjuvant radiotherapy. For the minority of patients who present with metastatic or recurrent disease not amenable to local control measures or oral hormonal therapy, chemotherapy can be administered. The following agents are known to have activity against endometrial adenocarcinoma: doxorubicin, cisplatin, carboplatin, ifosfamide, and paclitaxel. Cyclophosphamide, 5-fluorouracil, and hexamethylmelamine are drugs that have shown promise, but data are as yet too sparse to draw definite conclusions about their effectiveness against endometrial adenocarcinoma. The 2 most commonly employed hormones used to suppress tumor growth have been megestrol acetate and medroxyprogesterone acetate. Based on the responses reported with hormonal therapy alone, some investigators have combined multiagent cytotoxic therapy with hormones. The highest response rates utilizing chemohormonal regimens have been reported when the cytotoxic regimen included doxorubicin and cisplatin. We review the response rates demonstrated in single- and multi-institutional trials of these agents when used alone or in combination to treat patients with advanced or recurrent metastatic endometrial adenocarcinoma.