Adjuvant chemotherapy for endometrial cancer.

OBJECTIVE: To review the role of adjuvant chemotherapy in endometrial cancer and to identify the groups of patients who were most likely to have benefit from adjuvant chemotherapy. METHODS: Bibliographic search was conducted for randomized trials involving chemotherapy given in an adjuvant setting for early stage endometrial cancer or advanced stage with minimal residual disease after surgery. The search included the National Library of Medicine's MEDLINE/PubMed database, studies cited in the reports, proceedings of international conferences, and registered clinical trials. Details of each trial were explored and summarized. RESULTS: Seven reports from 8 randomized trials were identified. Two trials were reported together with separate and combined statistical analyses. Characteristic features of the patients and diseases, details of surgical treatment including lymph node resection, types and pattern of radiation and chemotherapy, and the results from each trial varied. Only 2 trials showed significant survival improvement in patients who had adjuvant chemotherapy alone or chemotherapy after radiation compared with radiation alone. Data from these trials showed that the patients who were likely to have survival benefit from adjuvant chemotherapy were those with the following high risk features: did not have or had limited lymph node surgical evaluation, metastatic nodal involvement, tumors of high-grade or aggressive histology, stage IC, stage II or IIIA with 50% or greater myometrial invasion, and stage IIIC to IV. CONCLUSIONS: The results from trials were inconsistent regarding a survival benefit of adjuvant chemotherapy in comparison to radiation alone or in addition to radiation. Only certain groups of patients with high risk features were likely to gain survival advantage from adjuvant chemotherapy. The physician must carefully evaluate risk features of each patient and her disease to select one who is most likely to gain advantage from chemotherapy.

Management of endometrial cancer in Asia: consensus statement from the Asian Oncology Summit 2009.

Endometrial cancer is one of the gynaecological cancers that carries good overall prognosis because it is often detected at early stages of disease. The International Federation of Gynecology and Obstetrics replaced clinical staging with surgical staging in 1988 and updated the system in 2009. Controversies remain regarding the recommended screening protocol for women with a high risk of endometrial cancer, the role and benefit of retroperitoneal lymph-node dissection, the necessity of ovarian resection, the benefit and type of adjuvant radiation therapy, and the safety of hormone-replacement therapy after treatment. This article reviews the available evidence for optimum management of endometrial cancer and how management strategies can be applied in Asian countries with different levels of health-care resource availability and economic development. An overview of the literature for endometrial-cancer screening, diagnosis, and management is discussed. Consensus statements are formulated on the basis of basic, limited, enhanced, and maximum health-care resource availability, using the framework provided by the Breast Health Global Initiative.

Phase I/II study of gemcitabine with pegylated liposomal doxorubicin as first-line therapy in Asian women with metastatic breast cancer.

This was a single institution phase I/II study to determine the maximum tolerated dose (MTD) and efficacy of pegylated liposomal doxorubicin (PLD) and gemcitabine in Asian women with metastatic breast cancer. PLD was administered on day 1 and gemcitabine on days 1 and 8 every 3 weeks at escalating doses from 25 mg/m(2) and 1000 mg/m(2) onwards respectively. The median age was 56 years with a median disease-free interval of 43 months. Majority of the patients had visceral involvement. At PLD 35 mg/m(2) and gemcitabine 1200 mg/m(2), the overall response rate for 23 evaluable patients was 83% (1 CR, 18 PR, 3 SD, 1 PD). Six had prior adjuvant anthracyclines (3 PR, 1 SD). The median follow-up was 81 weeks and progression free interval was 29 weeks. Overall survival was 23.9 months. The dose limiting toxicities were mucositis and myelosuppression. This regimen is active and reasonably tolerated as first-line therapy.

Novel agents in epithelial ovarian cancer.

The gold standard chemotherapy for previously untreated patients with ovarian cancer is currently a combination of taxane and platinum. However, most patients still suffer relapse, and less than 20% of the patients with stage III or IV disease survive long term. With more advanced technology, newer cytotoxic agents have been identified and are currently being tested in patients with ovarian cancer. Recent advances in the understanding of ovarian cancer biology have also led to the identification of multiple molecular targets that may soon change the standard treatment of ovarian cancer. Several of these targeted agents have entered clinical trials. Small molecular-weight inhibitors, monoclonal antibodies, antisense therapy, and gene therapy are all being evaluated alone and in combination with cytotoxic chemotherapy. Several of these cytotoxic and targeted therapies are reviewed here. Ultimately, the success of ovarian cancer therapy lies not just in the availability of new agents but in the ability to identify patients with biomarkers that may predict their response to these agents.

Quick-FLIC--a short questionnaire for assessing quality of life of cancer patients.

Health-related quality of life instruments tend to include a great many items. This imposes a burden on the respondents as well as undermining response rate and data quality. In this study we developed a shortened version of the Functional Living Index-Cancer (FLIC), now called Quick-FLIC, and examined its measurement properties. A questionnaire package, self-administered by 140 patients, included the FLIC and the Functional Assessment of Cancer Therapy-General. A factor analysis and clinical judgement were used to shorten the FLIC, which included 22 items. Each subscale of FLIC was shortened to include two or three items only. The Quick-FLIC included a total of only 11 items. Nevertheless, the measurement properties of the Quick-FLIC and its subscales were comparable to those of the original FLIC. It is concluded that the shortening of established health-related quality of life instruments is viable in oncology research.