Neoadjuvant Chemotherapy in Advanced Stage Endometrial Cancer: A Diverse, Urban Health System's Experience

Document Type

Conference Proceeding

Publication Date

5-1-2026

Publication Title

Gynecol Oncol

Keywords

protein p53, Caucasian, cohort analysis, conference abstract, cytoreductive surgery, diagnosis, drug therapy, endometrium cancer, female, follow up, histology, human, human tissue, major clinical study, medical record review, neoadjuvant chemotherapy, open surgery, response evaluation criteria in solid tumors, retrospective study, surgery, tumor burden

Abstract

Objectives: Primary cytoreductive surgery is the standard of care for advanced stage endometrial cancer (EC). Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is an alternative treatment strategy that is emerging with no clinical trials to support its standardization. We aim to explore clinicopathological factors associated with survival outcomes in a single institutional cohort of patients with EC who underwent NACT. Methods: Retrospective chart review of 42 patients with advanced stage EC who underwent NACT with IDS from 2012–2024 was performed. Demographic and clinicopathological information on imaging, treatment, surgery, recurrence and survival outcomes was collected. Response to NACT was assessed using RECIST criteria. Statistical analysis was performed using a combination of Fischer's Exact test and Cox analysis. Kaplan-Meier survival curves were created for variables of interest. Results: Out of 42 patients, 45.2% were black, 54.8% were white. Average age at diagnosis was 68 years and average BMI was 32.3. Most common histology was serous 47.6% followed by endometrioid 28.6%. 78.6% were grade 3. Radiographic stage at diagnosis was as follows: 71.4% stage IV, 26.2% stage IIIC, 2.4% stage IIIB. Average CA125 at diagnosis was 117. All patients received 3–6 cycles of platinum based and taxane chemotherapy. Response to NACT was as follows: CR 11.9%, PR 61.9%, SD 9.5%, PD 16.7%. 78.6% underwent open surgery, 21.4% underwent robotic approach. R0 status was achieved in 83.3%. Final pathology revealed 23 patients with dMMR, 6 pMMR, 16 p53 aberrant and 15 p53 WT. Out of 23 patients with CR or PR, 21 were dMMR & 14 were p53 aberrant. 69% of patients had recurrence of disease. 1-year OS was 81% and 5-year OS was 23%. OS & PFS were consistently higher in patients with R0 resection throughout the follow up period. OS did not differ by MMR status at any point in time, and PFS was similar up to 19 months with dMMR revealing better PFS afterwards. OS and PFS were similar in both p53 groups up to 29 months and 8 months respectively, with better outcomes observed in p53 WT group afterwards. On univariate analysis, only R0 status was associated with OS. R0 status, open surgery and response to NACT were associated with PFS. Statistical significance was not observed on multivariate analysis for any of the variables. Conclusions: The primary goal of NACT is to reduce tumor burden, allowing for complete resection and less morbid surgical interventions. Our data suggests that optimal debulking remains the main factor associated with improved OS & PFS in advanced stage EC. Open surgery and response to NACT are associated with improved PFS but not OS. dMMR EC appears to have better response to NACT. Statistical significance was difficult to achieve in our study on multivariate analysis due to small population size. Future research with larger cohort is needed to confirm these findings and better guide patient selection for NACT in advanced stage EC. [Formula presented]

Volume

208

First Page

S313

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