‘Definitive’ Data Support Radiation Omission in Advanced Endometrial Cancer

Video

The addition of radiation to chemotherapy did not improve overall survival in patients with advanced endometrial cancer, according to an expert from Northwestern Medicine.

Despite the prevalence in use of radiation therapy plus chemotherapy in endometrial cancer, “definitive” data suggest that chemotherapy alone is “sufficient” for treating this population, according to Daniela E. Matei, MD.

In a conversation regarding findings from a phase 3 trial (NCT00942357) presented at The Society of Gynecologic Oncology (SGO) 2023 Annual Meeting on Women’s Cancer, Matei, chief of Reproductive Science in Medicine in the Department of Obstetrics and Gynecology; a Diana, Princess of Wales, Professor of Cancer Research; and a professor of Medicine and Obstetrics and Gynecology at Northwestern Medicine, spoke with CancerNetwork® about challenges that may exist in updating the treatment paradigm in light of these findings.

In the trial, the addition of radiation to chemotherapy did not increase overall survival (OS) compared with chemotherapy alone (Hazard ratio, 1.05; 95% CI, 0.82-1.34; P = .72). As there is no additional survival benefit and additional toxicities associated with radiotherapy, Matei asserted that omission would be the best strategy.

Transcript:

The final [OS] analysis also shows that the combined regimen of chemotherapy and radiotherapy did not improve [OS]. The hazard ratio was 1.05, meaning that systemic chemotherapy alone is sufficient for treat treating [patients] with stage III endometrial cancer.

This is a seminal study that asked a fundamental question. Basically, the results of this study support the fact that systemic chemotherapy should be the mainstay of treatment for [patients] with stage III endometrial cancer and that radiation, which adds toxicity, can be omitted.

I hope that my colleagues take away the data; the data are definitive. There has been some debate in the field because for many decades, radiation therapy has been such an integral part of treatment for patients with endometrial cancer, and it’s also used for [patients] with early-stage endometrial cancer at high risk for recurrence. Because this has been ingrained in the field for so many years, a change in the paradigm of treatment is somewhat difficult. I hope that my colleagues look at the data and really interpret it for what it is.

Reference

Matei DE, Enserro D, Kudrimoti M, et al. Overall survival in NRG258, a randomized phase III trial of chemo-radiation vs. chemotherapy alone for locally advanced endometrial carcinoma. Presented at: 2023 SGO Annual Meeting on Women’s Cancer; March 25-28, 2023; Tampa, Florida.

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