Clinical Review

2020 Update on gynecologic cancer

Zhen Ni Zhou, MD, PhD

Dr. Zhou is a Fellow in the
Division of Gynecologic
Oncology, New York–
University Medical Center and
Weill Cornell Medical Center,
New York, New York.

Jason D. Wright, MD

Dr. Wright is the Sol Goldman
Associate Professor, Chief of
the Division of Gynecologic
Oncology, Vice Chair of
Academic Affairs, Department
of Obstetrics and Gynecology,
Columbia University College of
Physicians and Surgeons,
New York, New York.

Dr. Wright reports that he is a consultant to Clovis Oncology and Tesaro, Inc, and has received research funding from Merck. Dr. Zhou reports no financial relationships relevant to this article.

Gynecologic malignancies continue to be a major cause of cancer-related mortality. In this article: adjuvant chemotherapy during and after radiation for high-risk endometrial cancers; PARP inhibitors with first-line chemotherapy and as maintenance therapy for ovarian cancer; and secondary cytoreductive surgeries for recurrent ovarian cancer.



Over the past year, major strides have been made in the treatment of gynecologic malignancies. In this Update, we highlight 3 notable studies. The first is a phase 3, multicenter, international, randomized clinical trial that demonstrated a significant improvement in both overall and failure-free survival with the use of adjuvant chemoradiation versus radiotherapy alone in patients with stage III or high-risk uterine cancer. Additionally, we describe the results of 2 phase 3, multicenter, international, randomized clinical trials in ovarian cancer treatment: use of poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors in combination with platinum and taxane-based chemotherapy followed by the PARP inhibitor as maintenance therapy, and secondary cytoreductive surgery in platinum-sensitive, recurrent ovarian cancer.

We provide a brief overview of current treatment strategies, summarize the key findings of these trials, and establish how these findings have changed our management of these gynecologic malignancies.

Adjuvant chemotherapy and radiotherapy improves survival in women with high-risk endometrial cancer

de Boer SM, Powell ME, Mileshkin L, et al; on behalf of the PORTEC Study Group. Adjuvant chemoradiotherapy versus radiotherapy alone in women with high-risk endometrial cancer (PORTEC-3): patterns of recurrence and post-hoc survival analysis of a randomised phase 3 trial. Lancet Oncol. 2019;1273-1285.

In the United States, it is estimated that more than 61,000 women were diagnosed with endometrial cancer in 2019.1 Women with endometrial cancer usually have a favorable prognosis; more than 65% are diagnosed with early-stage disease, which is associated with a 95% 5-year survival rate.1 However, 15% to 20% of patients have disease with high-risk features, including advanced stage (stage II-IV), high tumor grade, lymphovascular space invasion, deep myometrial invasion, or nonendometrioid histologic subtypes (serous or clear cell).2 The presence of these high-risk disease features is associated with an increased incidence of distant metastases and cancer-related death.

Adjuvant therapy in high-risk endometrial cancer

To date, the optimal adjuvant therapy for patients with high-risk endometrial cancer remains controversial. Prior data from Gynecologic Oncology Group (GOG) protocol 122 demonstrated that chemotherapy significantly improved progression-free survival and overall survival when compared with radiotherapy in patients with advanced-stage endometrial cancer.3 As such, chemotherapy now is frequently used in this population, often in combination with radiation, although data describing the benefit of chemoradiation are limited.4 For women with earlier-stage disease with high-risk features, the value of chemotherapy plus radiation is uncertain.5,6

Continue to: Benefit observed with adjuvant chemoradiotherapy...


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