title: Prospective multicenter randomized intermediate biomarker study of oral contraceptive versus depo-provera for prevention of endometrial cancer in women with Lynch syndrome.
abstract: Women with Lynch syndrome have a 40% to 60% lifetime risk for developing endometrial cancer, a cancer associated with estrogen imbalance. The molecular basis for endometrial-specific tumorigenesis is unclear. Progestins inhibit estrogen-driven proliferation, and epidemiologic studies have shown that progestin-containing oral contraceptives (OCP) reduce the risk of endometrial cancer by 50% in women at general population risk. It is unknown whether they are effective in women with Lynch syndrome. Asymptomatic women ages 25 to 50 with Lynch syndrome were randomized to receive the progestin compounds Depo-Provera (depo-MPA) or OCP for three months. An endometrial biopsy and transvaginal ultrasound were conducted before and after treatment. Endometrial proliferation was evaluated as the primary endpoint. Histology and a panel of surrogate endpoint biomarkers were evaluated for each endometrial biopsy as secondary endpoints. A total of 51 women were enrolled, and 46 completed treatment. Two of the 51 women had complex hyperplasia with atypia at the baseline endometrial biopsy and were excluded from the study. Overall, both depo-MPA and OCP induced a dramatic decrease in endometrial epithelial proliferation and microscopic changes in the endometrium characteristic of progestin action. Transvaginal ultrasound measurement of endometrial stripe was not a useful measure of endometrial response or baseline hyperplasia. These results show that women with Lynch syndrome do show an endometrial response to short-term exogenous progestins, suggesting that OCP and depo-MPA may be reasonable chemopreventive agents in this high-risk patient population.
authors: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. khlu@mdanderson.org
authors: Karen H
authors: KH
authors: Lu
authors: David S
authors: DS
authors: Loose
authors: Melinda S
authors: MS
authors: Yates
authors: Graciela M
authors: GM
authors: Nogueras-Gonzalez
authors: Mark F
authors: MF
authors: Munsell
authors: Lee-May
authors: LM
authors: Chen
authors: Henry
authors: H
authors: Lynch
authors: Terri
authors: T
authors: Cornelison
authors: Stephanie
authors: S
authors: Boyd-Rogers
authors: Mary
authors: M
authors: Rubin
authors: Molly S
authors: MS
authors: Daniels
authors: Peggy
authors: P
authors: Conrad
authors: Andrea
authors: A
authors: Milbourne
authors: David M
authors: DM
authors: Gershenson
authors: Russell R
authors: RR
authors: Broaddus
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism*; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000150:complications*; D003276:Contraceptives, Oral / Q000627:therapeutic use*; D016889:Endometrial Neoplasms / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor; D003276:Contraceptives, Oral; D017258:Medroxyprogesterone Acetate
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