Drug treatment for endometrial cancer - how much do you know about chemotherapy and progestin therapy?

Author: Zhang Jingfei, deputy chief physician, Beijing Century Altar Hospital, Capital Medical University

Zhao ZheAttending physician at Beijing Century Altar Hospital, Capital Medical University

Reviewer: Bai Wenpei, Chief Physician, Beijing Century Altar Hospital, Capital Medical University

The commonly used drugs for treating endometrial cancer are mainly chemotherapy drugs and progestins.

When is chemotherapy necessary? When is progesterone necessary? What are the commonly used drugs? Are the side effects serious? Let's learn about it together.

Chemotherapy:

①In what cases is chemotherapy necessary to treat endometrial cancer?

Currently, chemotherapy is one of the important adjuvant treatments for endometrial cancer. It is suitable for the following patients:

First, postoperative adjuvant therapy for patients with early high-risk and late metastatic disease. What is high risk? For example, patients with invasive tissue types such as poorly differentiated endometrioid carcinoma, clear cell carcinoma, carcinosarcoma, serous carcinoma, undifferentiated carcinoma and dedifferentiated carcinoma are usually recommended to receive chemotherapy.

Second, patients with relapse, that is, patients who relapse after treatment, most of these patients need to choose chemotherapy.

Third, advanced patients with distant metastasis should first undergo chemotherapy, which is called neoadjuvant chemotherapy, to reduce the size of the tumor and then evaluate the feasibility of surgery or radiotherapy.

Fourth, patients who cannot tolerate surgery.

②What are the chemotherapy drugs commonly used for patients with endometrial cancer?

The preferred chemotherapy drug is paclitaxel plus carboplatin, known as the TC regimen. Because this combination has relatively mild side effects and a very good therapeutic effect, it is a first-line treatment option.

Figure 1 Original copyright image, no permission to reprint

Of course, there are some other drugs, such as doxorubicin, cisplatin, liposomal mycin, albumin paclitaxel, docetaxel, ifosfamide, etc. These chemotherapy drugs also have certain effects on patients with endometrial cancer.

In addition, for some advanced patients, immunotherapy and targeted therapy can be added, such as pembrolizumab combined with chemotherapy drugs or bevacizumab combined with chemotherapy drugs. Studies have shown that combined use can improve efficacy. In addition, endocrine therapy also has a place in the treatment of some endometrial cancer patients.

③What are the common side effects of chemotherapy drugs used to treat endometrial cancer?

Chemical drugs can kill tumor cells after entering the body through oral or intravenous injection, but at the same time, they will also have a certain killing effect on our normal cells.

Patients who use chemotherapy drugs for a long time will have some typical side effects:

First, digestive tract reactions. Nausea, vomiting, and loss of appetite are the most common side effects of chemotherapy drugs. If the above situations occur, first of all, you should relieve your nervousness and not be too afraid; at the same time, you should eat more light, easily digestible food, and eat small meals frequently; in addition, it is recommended to preventively use antiemetics, such as 5-hydroxytryptamine receptor blockers, neurokinin 1 receptor antagonists, glucocorticoids, etc., which can greatly alleviate digestive tract side effects.

Second, bone marrow suppression. After chemotherapy, the white blood cell count will decrease. We can take orally or subcutaneously some drugs that increase white blood cells to ensure the number of white blood cells, so as to ensure that we can persist in completing chemotherapy. If the white blood cell count is allowed to decrease, the resistance will decrease, and it is easy to get infected, such as colds and fevers. If the white blood cell count is particularly low, the patient must insist on wearing a mask, and even the room must be disinfected with ultraviolet light, and some antibiotics should be used preventively to prevent infection. In addition to observing white blood cells, you should also pay attention to changes in platelets and hemoglobin.

Third, hair loss. Many chemotherapy patients will experience hair loss, which is also a common side effect. Wearing a pressure headgear or ice cap before chemotherapy can prevent hair loss to a certain extent. You can also buy a wig or hat before chemotherapy so that it is convenient to wear when going out. However, you don’t need to worry too much. Usually, after stopping chemotherapy drugs, hair will gradually regenerate, and this side effect is mostly reversible.

Figure 2 Original copyright image, no permission to reprint

Fourth, other side effects such as liver damage, kidney damage, etc. These side effects are generally reversible and can be slowly recovered after stopping the medication.

Progestin therapy:

①In what cases is it necessary to use progestin to treat endometrial cancer?

Progestin therapy is a unique endocrine therapy for endometrial cancer and is mainly applicable to the following situations:

First, progestin therapy is mainly used for some young, early-stage endometrial cancer patients, especially those who wish to preserve their fertility.

Second, for some patients with advanced or recurrent disease who cannot tolerate surgery, some progestin treatment can also be added.

②What are the treatment methods for endometrial cancer with progestin?

There are three different forms of progestin therapy:

The first type is oral administration of large doses of progestins, such as medroxyprogesterone (MPA), megestrol acetate (MA), etc.

The second type is intramuscular injection of progesterone caproate;

The third type is that women who retain their uterus can place a special contraceptive ring in the uterus after conservative drug treatment - the levonorgestrel-releasing intrauterine system. This ring can regularly release progesterone, causing endometrial atrophy, which has a positive effect on the treatment of endometrial cancer.

In addition to progestins, there are some other endocrine therapy drugs available for clinical use, such as aromatase inhibitors, tamoxifen, and fulvestrant.

③What are the possible adverse reactions when patients with endometrial cancer use progestin treatment?

There are also some side effects of using progestin therapy:

First, headache and dizziness are more common.

Second, a small number of patients experience increased appetite, which causes weight gain. In addition, large doses of progesterone can cause water and sodium retention, leading to weight gain.

Third, there is a more serious side effect, which is that it may cause blood clots in some high-risk patients with thicker blood. Therefore, patients with a high risk of blood clots, such as those with cerebrovascular diseases, are not suitable for progesterone treatment.