New therapeutic approaches for the fertility‐sparing treatment of endometrial cancer

Mitsuhashi, Akira; Shozu, Makio

doi:10.1111/jog.14155

Cited by 11 publications

(10 citation statements)

References 53 publications

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“…In addition, several reports confirmed the effects of metformin, which is a biguanide widely prescribed for the treatment of type 2 diabetes mellitus [29]. Mitsuhashi et al [30] conducted phase II study of MPA plus metformin as a fertility-sparing treatment option for patients with endome- [14].…”

Section: Discussionmentioning

confidence: 98%

Endometrial cancer with tubal metastasis detected during laparoscopic surgery in a patient undergoing fertility-sparing treatment with medroxyprogesterone acetate: a case report and review of the literature

Deura¹,

Nagasawa²,

Kanamori³

et al. 2021

European Journal of Gynaecological Oncology

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Objectives: Medroxyprogesterone acetate (MPA) therapy is useful as a fertility-sparing treatment for early endometrial cancer, but it poses a risk of progression and recurrence during the treatment. We report a case of endometrial cancer with tubal metastases after long-term MPA therapy and review the literatures focusing on the failure of fertility-sparing treatment. Case: A nulliparous, 40 years old woman was started on MPA therapy after being diagnosed with grade 1 endometrioid carcinoma confined to the endometrium. She achieved complete remission after 10 months of treatment, but no pregnancy was established by assisted reproductive technology (ART). Eleven months after the first MPA therapy ended, atypical endometrial hyperplasia was confirmed. The disease was in remission again after the second MPA therapy for 8 months. The patient did not become pregnant by subsequent ART. Finally, a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed. The gross pathological specimen revealed a 13 mm mass near the left uterine cornu. Histopathology showed a left tube metastasis. She was diagnosed with FIGO stage IIIA endometrial cancer and underwent the staging surgery by laparotomy. After the second surgery, adjuvant chemotherapy was initiated. After 13 months of diseasefree survival, a recurrence was histologically detected at the vaginal stump. Following intracavitary radiation therapy, there was no evidence of disease for 10 months. Conclusions: The patient undergoing fertility-sparing treatment should be apprised of a risk of life-threatening progression of the disease. Once the patient has opted out of fertility preservation, definitive hysterectomy should be strongly recommended.

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Section: Discussionmentioning

confidence: 98%

Endometrial cancer with tubal metastasis detected during laparoscopic surgery in a patient undergoing fertility-sparing treatment with medroxyprogesterone acetate: a case report and review of the literature

Deura¹,

Nagasawa²,

Kanamori³

et al. 2021

European Journal of Gynaecological Oncology

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“…Generally, the attack of early endometrial cancer in young patients has associations with factors such as obesity, insulin resistance, ovulation disorders, and infertility [ 10 ]. Studies have manifested that obesity and insulin resistance are related factors for the high recurrence rate and long duration of conservative treatment of endometrial cancer [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Metformin in Combination with Progesterone Improves the Pregnancy Rate for Patients with Early Endometrial Cancer

Yuan

Han

et al. 2022

Contrast Media & Molecular Imaging

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Objective. To study the therapeutic effects of metformin in combination with medroxyprogesterone in the early endometrial cancer patients with fertility requirements. A total of 120 patients with early endometrial cancer admitted to and treated in our hospital were enrolled and evenly assigned into two groups according to different therapeutic regimens, namely, metformin group (metformin combined with medroxyprogesterone acetate) and control group (medroxyprogesterone acetate alone). The objective response rate (ORR) and disease control rate (DCR) were 71.7% (43/60) and 90.0% (54/60) in the metformin group and 53.3% (32/60) and 78.3% (47/60) in the control group, respectively. Adverse reactions such as gastrointestinal reaction, headache, and insomnia were mainly observed in patients. The body mass index (BMI) declined from (34.43 ± 4.34) kg/m2 to (24.77 ± 2.39) kg/m2 in the metformin group and from (33.37 ± 4.49) kg/m2 to (31.28 ± 3.55) kg/m2 in the control group after treatment. After treatment, serum levels of vascular endothelial growth factor (VEGF), angiotensin-2 (Ang-2), carbohydrate antigen 125 (CA125), and CA19-9 in the metformin group were significantly lower than those in the control group (P = 0.005, P < 0.001, P = 0.002, and P < 0.001). During follow-up, the pregnancy rate was 81.7% (49/60) in the metformin group and 61.7% (37/60) in the control group, and the former was prominently higher than the latter (P = 0.025). Metformin in combination with progesterone is effective in treating early endometrial cancer patients with fertility requirements, which significantly reduced the BMI of patients and increased the pregnancy rate after treatment.

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“…Most young patients with AEH and EC who undergo fertility-sparing treatment have a background of obesity, IR and abnormal glucose tolerance complicated with polycystic ovary syndrome. Metformin had been used to counteract with these metabolic syndromes and has been attracting more attention in the field of cancer research ( 30 ). Metformin is an insulin sensitizer and has been widely investigated to treat various malignant diseases adjunctively.…”

Section: Discussionmentioning

confidence: 99%

Insulin Resistance and Metabolic Syndrome Increase the Risk of Relapse For Fertility Preserving Treatment in Atypical Endometrial Hyperplasia and Early Endometrial Cancer Patients

Yuan

Wang

et al. 2021

Front. Oncol.

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ObjectiveFertility-sparing treatment for young women with atypical endometrial hyperplasia (AEH) and early endometrial cancer (EC) is a difficult challenge. Insulin resistance (IR) and metabolic syndrome (MetS) are two potentially crucial, but currently enigmatic factors in the recurrence of AEH and early EC patients. In this study we attempt to elucidate these factors.MethodsA retrospective study was conducted from January 2010 to December 2019. Risk factors for recurrence and complete remission time after recurrence (RCR time) were investigated. ROC curves were built to estimate the accuracy of the metabolic characteristics and Kaplan–Meier (K–M) analysis was used to calculate recurrence-free survival (RFS) for patients with various IR or MetS statuses.ResultsA total of 111 AEH or early EC patients met the criteria and were enrolled in our study. Univariate analysis found that BMI ≥25 kg/m2 (OR = 2.7, 95% CI: 1.1–6.4, P = 0.03), IR (OR = 9.5, 95% CI: 3.3–27.0, P <0.001), MetS (OR = 4.9, 95% CI:1.5–15.5, P = 0.008), IR+ and MetS+ (OR = 21.0, 95% CI: 4.8–92.7, P <0.001), histological type (OR = 3.5, 95% CI: 1.5–7.9, P = 0.003), and maintenance treatment (OR = 0.3, 95% CI: 0.1–0.6, P = 0.005) were all significantly associated with recurrence and longer RCR time. Among these factors, IR and MetS were determined to be two independent risk factors for recurrence. Moreover, using IR and MetS as markers significantly improved the diagnostic accuracy of recurrence for fertility-sparing treatment patients (AUC = 0.818, P <0.05) and may play synergistic roles in suppressing treatment. K–M analysis indicated both metabolic features played important roles in RFS (P <0.05).ConclusionBoth IR and MetS were significantly associated with recurrence and longer RCR time in AEH and early EC patients receiving fertility-sparing treatment.

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New therapeutic approaches for the fertility‐sparing treatment of endometrial cancer

Cited by 11 publications

References 53 publications

Endometrial cancer with tubal metastasis detected during laparoscopic surgery in a patient undergoing fertility-sparing treatment with medroxyprogesterone acetate: a case report and review of the literature

Endometrial cancer with tubal metastasis detected during laparoscopic surgery in a patient undergoing fertility-sparing treatment with medroxyprogesterone acetate: a case report and review of the literature

Metformin in Combination with Progesterone Improves the Pregnancy Rate for Patients with Early Endometrial Cancer

Insulin Resistance and Metabolic Syndrome Increase the Risk of Relapse For Fertility Preserving Treatment in Atypical Endometrial Hyperplasia and Early Endometrial Cancer Patients

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