Beleid bij recidief/gemetastaseerd endometriumcarcinoom

Presentatie over: "Beleid bij recidief/gemetastaseerd endometriumcarcinoom"— Transcript van de presentatie:

1 Beleid bij recidief/gemetastaseerd endometriumcarcinoom
Philippe Van Trappen MD PhD Gynaecologisch/Oncologisch chirurg AZ Sint-Jan Brugge VVOG Jaarcongres 10-11/10/2013 Genk

2 Beleid bij recidief/gemetastaseerd endometriumcarcinoom
Inhoud: Locatie recidief/metastasen endometrium carcinoom Beeldvorming bij diagnose van recidief/metastasen Chirurgie bij recidief endometrium carcinoom Chemotherapie bij recidief/gemetastaseerd endometrium carcinoom Moleculaire target therapieën

3 Locatie van recidief/gemetastaseerd endometriumcarcinoom
. Location of Disease in Patients Who Die From Endometrial Cancer: A Study of 414 Patients From a Single Institution. Barlin, Joyce; Wysham, Weiya; Ferda, Aaron; Khoury-Collado, Fady; Cassella, Danielle; Alektiar, Kaled; Hensley, Martee; Chi, Dennis; Barakat, Richard; Abu-Rustum, Nadeem International Journal of Gynecological Cancer. 22(9): , November 2012

4 TABLE 1 Follow-up status of patients with endometrial cancer
Location of Disease in Patients Who Die From Endometrial Cancer: A Study of 414 Patients From a Single Institution. Barlin, Joyce; Wysham, Weiya; Ferda, Aaron; Khoury-Collado, Fady; Cassella, Danielle; Alektiar, Kaled; Hensley, Martee; Chi, Dennis; Barakat, Richard; Abu-Rustum, Nadeem International Journal of Gynecological Cancer. 22(9): , November 2012. TABLE 1 Follow-up status of patients with endometrial cancer 2

5 Location of Disease in Patients Who Die From Endometrial Cancer: A Study of 414 Patients From a Single Institution. Barlin, Joyce; Wysham, Weiya; Ferda, Aaron; Khoury-Collado, Fady; Cassella, Danielle; Alektiar, Kaled; Hensley, Martee; Chi, Dennis; Barakat, Richard; Abu-Rustum, Nadeem International Journal of Gynecological Cancer. 22(9): , November 2012. TABLE 2 Clinical characteristics of all patients with endometrial cancer and patients who died of the disease FIGO IB (2009) 3

6 Location of Disease in Patients Who Die From Endometrial Cancer: A Study of 414 Patients From a Single Institution. Barlin, Joyce; Wysham, Weiya; Ferda, Aaron; Khoury-Collado, Fady; Cassella, Danielle; Alektiar, Kaled; Hensley, Martee; Chi, Dennis; Barakat, Richard; Abu-Rustum, Nadeem International Journal of Gynecological Cancer. 22(9): , November 2012. TABLE 3 Location of disease at the time of death for patients with endometrial cancer who died of the disease 4

7 Location of Disease in Patients Who Die From Endometrial Cancer: A Study of 414 Patients From a Single Institution. Barlin, Joyce; Wysham, Weiya; Ferda, Aaron; Khoury-Collado, Fady; Cassella, Danielle; Alektiar, Kaled; Hensley, Martee; Chi, Dennis; Barakat, Richard; Abu-Rustum, Nadeem International Journal of Gynecological Cancer. 22(9): , November 2012. FIGURE 1 . Location of disease at time of death for patients with endometrial cancer who died of the disease. 5

8 TABLE 4 Adjuvant treatment for patients who died of disease
Location of Disease in Patients Who Die From Endometrial Cancer: A Study of 414 Patients From a Single Institution. Barlin, Joyce; Wysham, Weiya; Ferda, Aaron; Khoury-Collado, Fady; Cassella, Danielle; Alektiar, Kaled; Hensley, Martee; Chi, Dennis; Barakat, Richard; Abu-Rustum, Nadeem International Journal of Gynecological Cancer. 22(9): , November 2012. TABLE 4 Adjuvant treatment for patients who died of disease 6

9 Endometriumcarcinoom patienten die overlijden aan hun ziekte:
overlevingsduur na primaire diagnose? - Mediane ziekte-vrije overleving: 12.3 maanden ( maanden) Mediane overleving: 20.5 maanden ( maanden) 80% recidiveert binnen de eerste 24 maanden Type I endometriumcarcinoom (endometrioïde type): mediane overleving: 25.8 maanden Type II/high risk endometriumcarcinoom (UPSC, Clear cel ca): mediane overleving: 16.4 maanden

10 Identificeren van recidief/gemetastaseerd endometriumcarcinoom

11 PET-CT in identificeren locatie recidief/gemetastaseerd
endometriumcarcinoom: SENSITIVITEIT

12 PET-CT in identificeren locatie recidief/gemetastaseerd
endometriumcarcinoom: SPECIFICITEIT

13 PET-CT in follow-up bij symptomatische/asymptomatische patiënten
met endometriumcarcinoom

14 Chirurgie recidief endometriumcarcinoom: bij wie?
Locoregionaal recidief/letsel in voorheen bestraalde regio (evidentie: level C). Enkel indien maximale resectie mogelijk is, cfr meta-analyse 2010 (vroeger enkel exenteratie als type chirurgie). Rekening houden met co-morbiditeiten (cave: obesitas; cardiovasculair, etc.) Is patiente fit voor debulking chirurgie/exenteratie?

15 FIT FOR SURGERY?

16

17 14 retrospective studies (n patients: 20 to 75)
Total of 672 patients Optimal cytoreduction: 52% to 75% Complete surgical resection: 18% to 75%

18 Complete chirurgische resectie bij locaal gevorderd of recidief endometriumcarcinoom
(GOG 122)

19 Beleid (palliatief) bij metastasen op afstand van een endometriumcarcinoom
Progesteron receptor + of ? tumor Progestageen (bvb Megestrol acetaat*) Progesteron receptor - tumor Chemotherapie (paclitaxel/carboplatimum) (Evidentie: level C) * Fiorica JV et al, Gynecol Oncol, 2004 (GOG): Response Rate 27%, Median OS 14 maanden.

20 Chemotherapie voor recidiverend/gemetastaseerd endometrium carcinoom: mono- of combinatietherapie?
Monotherapie Response Rate (RR) Cisplatinum 4-42% Carboplatinum 28-33% Doxorubicin 37% Epirubicin 26% 5-FU 41% Paclitaxel 36% Docetaxel 7.7-31% Gemcitabine 11% Grisham RN et al, Int J Gynecol Cancer, 2012 Nomura H et al, Ann Oncol, 2011 Katsumata N et al, Br J Cancer, 2005

21 Median Overall Survival
Chemotherapie voor recidiverend/gemetastaseerd endometrium carcinoom: mono- of combinatietherapie? Combinatietherapie Response Rate (RR) Median Overall Survival (maanden) Cisplatinum+Docetaxel1 51.7% 21 Carboplatinum+Docetaxel1 48.3% 24 Carboplatinum+Paclitaxel1,2 60-67% 28 Carboplatinum+Paclitaxel+Epirubicin3 50% 26 Carboplatinum+Pegyl.Lip.Doxorubicin4 44% 21.4 Nomura H et al, Ann Oncol, 2011 Sorbe B et al, Int J Gynecol Cancer, 2008 Egawa-Takata T et al, Cancer Chem Pharm, 2011 du Bois A et al, Gynecol Oncol, 2007

22 Gemcitabine for Advanced Endometrial Cancer: A Retrospective Study of the Memorial Sloan-Kettering Cancer Center Experience. Grisham, Rachel; Adaniel, Christina; Hyman, David; Ma, Weining; Iasonos, Alexia; Aghajanian, Carol; Konner, Jason International Journal of Gynecological Cancer. 22(5): , June 2012.

23 TABLE 3 Response by histology
Gemcitabine for Advanced Endometrial Cancer: A Retrospective Study of the Memorial Sloan-Kettering Cancer Center Experience. Grisham, Rachel; Adaniel, Christina; Hyman, David; Ma, Weining; Iasonos, Alexia; Aghajanian, Carol; Konner, Jason International Journal of Gynecological Cancer. 22(5): , June 2012. TABLE 3 Response by histology 4

24 2 verschillende casussen recidief endometriumcarcinoom
72jr Type 1 endom ca, FIGO IB, G3 Primaire behandeling: TAH-BSO + pelviene LND + adj ERT + IVBT RECIDIEF enkel thv vaginatop na 24 mnd: R/? Chirurgie + hormonale R/ 74jr Type 2 endom ca (UPSC, Prog R -), FIGO IIIC, G3 TAH-BSO + Pelv/Para-aort LND + omentum + biopten adj paclitaxel/carboplatinum RECIDIEF met intra-abdominale metastasen + vergrote para-aortische klieren (PET +) en + pleuravocht na 12 mnd Chemo (carboplatinum+paclitaxel) “almost 40% can be salvaged” (Rosenberg et al, 1993) “all patients who recurred from their UPSC died of their disease (Rosenberg et al, 1993)

25 Toekomst: moleculaire targets in endometrium carcinoom

26 Moleculaire target therapie in endometrium carcinoom

27 Moleculaire target therapie in endometrium carcinoom: Phase II trials