The Role of Platins in Newly Diagnosed Endometrial Cancer

Twenty percent of women with endometrial cancer will die from it, predominantly from systemic spread. Chemotherapy is, therefore, needed both for "high risk" women at diagnosis (stages III and IV - all histologies; stage 11 Clear Cell or grade 3; Papillary Serous or MMMT, irrespective of stage) and for relapsers, unless grade 1, when hormones are a preferable initial option. The most active single agents are: the anthracyclines, taxanes and platins; response rates 17-37, 21-67 and 13-14%, respectively. Combinations have proven to be superior in terms of relapse but not survival. Taxane-/platin-containing regimens are the phase III proven best combinations. The GOG is currently comparing the two "winning combinations", doxorubicin/cisplatin + paclitaxel + GCSF and carboplatin-paclitaxel. As carboplatin-paclitaxel is a more convenient and less toxic regimen, it would be preferable if equally efficacious. It is likely that other platinum doublets are equally good. Platin/vinorelbine or carboplatin-pegylated liposomal doxorubicin have similar RRs to platin/taxane in phase II studies. Chemotherapy, predominantly cisplatin-doxorubicin, has improved Survival in 3 of the 4 phase III studies conducted, in comparison to irradiation. Progression still was seen in Lip to 50% (dependant upon stage). Using "platin/taxane" should improve this somewhat, but adding agents directed at molecular targets, e.g., EGFR, VEGF, AKt will be required.