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Abstract
Introduction/Background Of 66,700 incident endometrial cancer (EC) cases expected in the United States in 2025, about 25,430 (38.1%) will be EC at high risk of recurrence (HR-EC). To elucidate on unmet needs in this population, this study described perioperative treatment patterns in elderly patients with HR-EC and overall survival (OS) by recurrence status in patients receiving adjuvant therapy (AT).
Methodology Patients aged ≥66 years with HR-EC (Stage I/II EC with non-endometroid histology or Stage III/IVA EC with any histology) who received hysterectomy and bilateral salpingo-oophorectomy were identified in SEER-Medicare data (2007–2019). Neoadjuvant therapy (NAT) and AT regimens were summarized overall and by stage. Among patients receiving AT, OS was estimated from a recurrence in patients with recurrence and from a frequency-matched index date in patients without recurrence using Kaplan-Meier analyses.
Results Among 2,279 patients with HR-EC receiving surgery, 43.3% received no perioperative treatments. NAT was limited, overall (3.1%) and by stage (Stage I [3.4%]; Stage II [0.9%]; Stage III/IVA [2.9%]); 81.4% of NAT was endocrine therapy. AT was more frequently used overall (55.2%) and by stage (Stage I [48.3%]; Stage II [67.7%]; Stage III/IVA [70.4%]); chemotherapy (50.6%), radiation therapy (33.5%), and chemoradiation (12.2%) were most common overall. In 1,198 patients receiving AT (median age: 72.7 years; Stage I/II disease: 71.3%; non-endometrioid carcinoma: 84.3%), 375 (31.3%) experienced a recurrence over a median follow-up of 3.7 years. Median OS was significantly shorter for patients with a recurrence than those without (1.3 years vs. not reached; p<0.001) (figure 1).
Conclusion Elderly patients with HR-EC receiving surgery had limited NAT and only half received AT. Disease recurrence was significantly associated with increased mortality in patients receiving AT. Our findings underscore the substantial clinical burden associated with recurrent disease in HR-EC, despite treatment with AT, and highlight an unmet need for novel and effective therapies in this population.
Disclosures Vimalanand S. Prabhu, Jin-Liern Hong, and Yezhou Sun are employees of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA.
Kalé Kponee-Shovein, Yan Song, Mu Cheng, Annalise Hilts, and Qi Hua are employees of Analysis Group, Inc., a consultancy that received funding from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA to conduct this study.
Jasmine Lichfield is an employee of MSD (UK) Limited, London, UK.
Kaplan-meier analysis of overall survival in patients with newly-diagnosed high-risk endometrial cancer by recurrence status