Gemcitabine for Advanced Endometrial Cancer

• DOI: 10.1097/igc.0b013e31824a33a2
• Publication Date: 2012-05-24T15:21:31Z
• Authors: Rachel Nicole Gri...; Christina Adaniel; David M. Hyman; Weining Ma; Alexia Iasonos; Carol Aghajanian; Jason Konner
• Keywords: Aged, 80 and over; Antimetabolites, Antineoplastic; Middle Aged; Prognosis; Deoxycytidine; Gemcitabine; Cystadenocarcinoma, Serous; Endometrial Neoplasms; 3. Good health; Survival Rate; 03 medical and health sciences; 0302 clinical medicine; CA-125 Antigen; Humans; Female; Neoplasm Recurrence, Local; Adenocarcinoma, Clear Cell; Aged; Follow-Up Studies; Neoplasm Staging; Retrospective Studies

Gemcitabine is active in several gynecologic malignancies including ovarian cancer, cervical cancer, and uterine leiomyosarcoma. It has been used in an off-label setting for the treatment of advanced endometrial cancer, despite lack of published data showing efficacy. We performed a retrospective study to determine the progression-free survival and response rate of endometrial cancer patients treated with gemcitabine at Memorial Sloan-Kettering Cancer Center.Eligible patients had histologically confirmed advanced (stage IV or recurrent) endometrial cancer that was treated with single-agent gemcitabine at Memorial Sloan-Kettering Cancer Center between 1999 and 2009. Response to therapy was determined by review of computed tomography imaging by Response Evaluation Criteria in Solid Tumors 1.1 criteria.Forty-six patients were included in the analysis. Median age was 66 years (range, 52-87 years). All patients were previously treated with chemotherapy. The median number of prior lines of chemotherapy was 2 (range, 1-8). Median dose of gemcitabine administered was 800 mg/m infused on days 1 and 8 of a 21-day cycle. Predominant histology was endometrioid (48%, n = 22) followed by serous (35%, n = 16), clear cell (15%, n = 7), and undifferentiated (2%, n = 1). Overall response rate was 10.9% (95% confidence interval, 1.9%-19.9%); 5 patients (11%) achieved a partial response. Thirteen patients (28%) displayed stable disease lasting at least 3 months. Of note, 5 (71%) of the 7 patients with clear cell histology displayed stable disease or partial response (n = 5). The median progression-free survival was 3.0 months (95% confidence interval, 2.1-3.3 months). Nonhematologic grades 3 and 4 toxicities were rare. Ten patients (22%) were treated with granulocyte colony-stimulating factor during treatment. Grade 3 thrombocytopenia was seen in 4 patients (9%). There were no cases of grade 4 thrombocytopenia.In a mixed population of patients with previously treated advanced endometrial cancer, gemcitabine was well tolerated and showed modest activity. Patients with clear cell histology appeared to have greater likelihood of benefit.