Uterine serous carcinoma: Reassessing effectiveness of platinum-based adjuvant therapy

• Published in: Gynecologic oncology 2018-05, Vol.149 (2), p.291-296
• Main Authors: Tortorella, Lucia, Langstraat, Carrie L., Weaver, Amy L., McGree, Michaela E., Bakkum-Gamez, Jamie N., Dowdy, Sean C., Cliby, William A., Keeney, Gary L., Sherman, Mark E., Weroha, Saravut J., Mariani, Andrea, Podratz, Karl C.
• Format: Article
• Language: English
• Subjects: Platinum-based chemotherapy; Therapeutic efficacy; Uterine serous carcinoma
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2018.02.022

Two randomized trials failed to demonstrate efficacy of platinum-based chemotherapy (PbCT) for uterine serous carcinoma (USC). Our objective was to reassess the value of PbCT for patients with microscopic residuum (R0). Progression-free survival (PFS) after surgery was analyzed for 409 patients and correlated with adjuvant therapies: vaginal brachytherapy (VBRT), external beam radiotherapy (EBRT), PbCT, or combinations. The estimated 5-year PFS for stage I (n=209) USC was 65.1% for observation only; 90.7%, VBRT only; and 91.1%, PbCT±VBRT (85% received VBRT); VBRT significantly (P=.004) impacted PFS, but the added value of PbCT remains uncertain. Of 58 stage IIIC, PbCT-treated patients (±EBRT), 5-year PFS was 33.9%; most failures had a vascular disseminated component. Median PFS for 72 stage IV, PbCT-treated patients was 18.6months for R0; 8.0, R1≤1cm residual disease; and 4.6, R2>1cm (P=.008). The progression rate (PR) during 1 to 2year follow-up for R0 was similar to PR during 0–1year follow-up for R1 (P=.31), suggesting recurrences in patients with R0 disease before 2years are likely platinum resistant. PRs during follow-up were nearly identical for R0≥2years and R1≥1year (P=.95), presumably showing limited numbers of platinum-sensitive tumors. A comparison of PR for patients treated with PbCT for stage IV R0 and R1 disease suggested that a 1-year lag interval precedes clinical recognition of PbCT refractory/resistant R0 disease. Most patients treated with PbCT who had microscopic residuum had recurrences within 2years (across stages), emphasizing the need for more effective therapy. •Most uterine serous carcinomas fail to respond to platinum-based chemotherapy.•Critical lag times precede declaration of platinum refractory microscopic disease.•Truncated survival/systemic failures compel a search for more effective therapy.