Chemoradiotherapy Regimen ‘Feasible’ For High-Risk Endometrial Cancer Patients

A combined adjuvant radiation and chemotherapy regimen may be acceptable for high-risk endometrial cancer despite more severe side effects than radiotherapy alone

medwireNews: Preliminary results from the phase III PORTEC-3 study suggest that the toxicity and quality of life (QoL) associated with adjuvant chemoradiotherapy may be manageable for women with high-risk endometrial cancer.

The 2-year secondary endpoint results for the trial’s comparison of 48.6 Gy radiation, given in 1.8 Gy fractions five times a week, with or without two concurrent cycles of cisplatin plus four cycles of carboplatin and paclitaxel, are published in The Lancet Oncology, ahead of the primary endpoint findings for overall survival and failure-free survival.

The patients, all of whom had International Federation of Gynecology and Obstetrics disease considered to be high risk, underwent total abdominal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy and were stratified on the basis of lymphadenectomy, disease histology and stage and participating centre.

EORTC Quality of Life Questionnaire Core 30 (QLQ-C30) responses were available for 194 of the 292 patients assigned to receive chemoradiotherapy and 170 of the 278 patients given radiation alone, report Stephanie de Boer, from Leiden University Medical Center in the Netherlands, and co-authors.

Patients given chemoradiotherapy had poorer functioning and health-related QoL scores at the end of radiotherapy and after 6 months than their radiation-treated counterparts.

By the 12- and 24-month checkpoints, global health and QoL were comparable in the treatment groups, albeit with slightly lower physical functioning in the patients given chemoradiotherapy.

But chemoradiotherapy patients were significantly more likely to report severe tingling or numbness than the radiation-only patients (25 vs 6%), the researchers say.

Toxicity results confirmed that patients given chemoradiotherapy were more than twice as likely to experience grade 2 or more severe side effects than patients given only radiotherapy (94 vs 44%), as well as grade 3 or worse side effects (61 vs 13%).

Nevertheless, at 12 and 24 months, the rate of grade 3 or more severe events did not significantly differ between the groups, with grade 2 or worse sensory neuropathy at 24 months the only symptom significantly more common with chemoradiotherapy (10 vs <1%).

“This schedule of combined chemotherapy and radiotherapy is feasible, and these data are essential for patient counselling and shared decision making on adjuvant chemotherapy”, write Stephanie de Boer et al.

“The question remains whether the impact in terms of toxicities will be outweighed by an overall or failure-free survival benefit”, they continue.

“Final analysis of the PORTEC-3 and GOG258 trials are awaited, to determine the benefit of chemoradiotherapy in women with high-risk endometrial cancer.”

Reference

de Boer SM, Powell ME, Mileshkin L, et al. Toxicity and quality of life after adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): an open-label, multicentre, randomised, phase 3 trial. Lancet Oncol 2016; Advance online publication 7 July. DOI: http://dx.doi.org/10.1016/S1470-2045(16)30120-6

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