Prognosis in advanced or recurrent endometrial cancer (aEC) is poor (5-year overall survival [OS] 15%-17%). Paclitaxel plus carboplatin (PC) is standard of care (SOC) first-line (1L) chemotherapy (CT), and no 2L SOC is established. We conducted a systematic literature review to assess the real-world effectiveness and safety of CTs in aEC.
MEDLINE, Embase, and the Cochrane Library and five relevant conference databases (2018-2020) were searched (January 2000-July 2020) for aEC studies that met prespecified inclusion/exclusion criteria. Uterine cancer was included to capture all relevant evidence. Key outcomes included OS, progression-free survival (PFS), and adverse events (AEs).
84 publications met the criteria, and most assessed outcomes in (neo)adjuvant settings. Totals of five and six studies reported OS or PFS in 1L and ≥2L, respectively. Studies were from the US (n=6), Asia (n=2), Europe (n=2), and South America (n=1), and sample sizes ranged from 20 to 3197. CTs in 1L studies included PC (n=2), taxane-based CT (n=1), platinum-based CT (n=1), or any CT (n=1); ≥2L CTs included PC (n=3), doxorubicin (n=2), or any platinum-based CT (n=1) Median OS (mOS) was reported in four of five 1L studies: 11 to 28.5 months with CT not specified, 16.9 months with taxane-based CT, and 12.5 months with PC. A median PFS (mPFS) of 5.1 months was reported in one study. All six ≥2L studies reported mOS and mPFS. Of the four studies that investigated platinum-based therapies, two provided results split by treatment-free interval (TFI). One study reported mOS as 13 months for patients with treatment-free intervals (TFI) ≥ 6 months from prior systemic therapy and 5.5 months for those with TFI < 6 months. AEs (from 3 studies) were nausea (18.9%), palmar-plantar erythrodysesthesias (16.4%), and muscle weakness (12.3%) for doxorubicin, neurotoxicity (0%-10.6%) and hypersensitivity reaction (0%-2.4%) for PC, and neutropenia (16%) for carboplatin plus epirubicin.
The limited evidence found low OS and PFS for aEC following CT in both 1L and ≥2L settings, further emphasizing the high unmet need for new treatment options in this aggressive indication.
Eisai Inc.
Eisai Inc.
All authors have declared no conflicts of interest.