Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, NY, USA.
Gynecol Oncol. 2022 Dec;167(3):540-546. doi: 10.1016/j.ygyno.2022.10.012. Epub 2022 Oct 22.
Endometrial cancer incidence and mortality are rising among all ethnic groups. Carboplatin plus paclitaxel is the established frontline treatment for advanced/recurrent disease; however, subsequent treatment with traditional cytotoxic chemotherapy is challenging. The molecular characterization of endometrial cancer has provided important insights into the biological drivers of carcinogenesis, which has allowed for the development of newer precision immunotherapies and targeted therapies, including pembrolizumab, dostarlimab, and lenvatinib. Until recently, platinum rechallenge was often considered at the time of recurrence, given the lack of other available therapeutic options; however, "platinum sensitivity" in endometrial cancer is subjective and largely based on expert opinion and/or practitioner experience. Small retrospective studies have tried to provide guidance on the utility of platinum rechallenge, but they are limited by variable patient characteristics and small sample sizes. The applicability of these retrospective studies to contemporary clinical practice is difficult in the setting of changing patient demographics, a better understanding of endometrial cancer drivers, and the recent approvals of immune checkpoint inhibitors and the combination of lenvatinib plus pembrolizumab in the second-line setting. The primary focus of this review is to distill the available data regarding platinum-doublet chemotherapy rechallenge and highlight recent pivotal developments in endometrial cancer treatment, as well as future directions.
子宫内膜癌的发病率和死亡率在所有种族中都呈上升趋势。卡铂联合紫杉醇是治疗晚期/复发性疾病的既定一线治疗方法；然而，随后使用传统细胞毒性化疗具有挑战性。子宫内膜癌的分子特征为癌症发生的生物学驱动因素提供了重要的见解，这使得新的精准免疫疗法和靶向疗法得以发展，包括 pembrolizumab、dostarlimab 和 lenvatinib。直到最近，由于缺乏其他可用的治疗选择，在复发时经常考虑重新使用铂类药物；然而，子宫内膜癌中的“铂类敏感性”是主观的，主要基于专家意见和/或从业者经验。小型回顾性研究试图为铂类药物重新使用的实用性提供指导，但它们受到患者特征和样本量小的限制。在患者人群特征变化、对子宫内膜癌驱动因素的更好理解以及最近免疫检查点抑制剂和 lenvatinib 联合 pembrolizumab 在二线治疗中的批准的背景下，这些回顾性研究在当代临床实践中的适用性具有一定难度。这篇综述的主要重点是总结有关铂类双联化疗重新使用的现有数据，并强调子宫内膜癌治疗的最新关键进展以及未来方向。
