title: Tumor grade and chemotherapy response in endometrioid endometrial cancer.
abstract: The objective of this study is to evaluate the association between tumor grade and response to chemotherapy in patients with endometrioid endometrial adenocarcinoma. Patients with advanced or recurrent endometrioid endometrial adenocarcinoma of known tumor grade who received at least 3 cycles of chemotherapy were retrospectively identified at three institutions. RECIST 1.1 criteria were used to assess response to neoadjuvant, postoperative or salvage chemotherapy. Chi-square testing was used to evaluate the association between tumor grade and chemotherapy response. Ninety-one patients met inclusion criteria: 13 with grade 1, 29 with grade 2 and 49 with grade 3 tumors. Eighty-four percent of patients received chemotherapy for recurrence, 12% for postoperative residual disease, and 4% in the neoadjuvant setting. The majority (85%) received carboplatin and paclitaxel. Forty-six percent (6/13) of grade 1, 72% (21/29) of grade 2 and 43% (21/49) of grade 3 tumors achieved an objective response. Grade 2 tumors were more likely to respond to chemotherapy compared to grade 3 tumors (72% vs. 43%, p = 0.02; Table 2), and specifically more likely to respond to carboplatin/paclitaxel (72% vs. 41%, p = 0.016). Median progression-free survival for patients receiving chemotherapy for recurrence or progression was 9 months for grade 1, 8 months for grade 2, and 5 months for grade 3 tumors. Similar results between grade and treatment response were apparent in the subset of 37 patients with a recently re-assigned tumor grade (G2 88% vs. G3 44%, p = 0.032). In this series of endometrioid endometrial cancers, grade 2 tumors had the best measurable response to chemotherapy.
authors.affiliation: Duke University, Division of Gynecologic Oncology Durham, NC, United States.
authors.forename: Brittany A
authors.initials: BA
authors.lastname: Davidson
authors.affiliation: Medical University of South Carolina, Division of Gynecologic Oncology Charleston, SC, United States.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Foote
authors.affiliation: University of North Carolina-Chapel Hill, Division of Gynecologic Oncology Chapel Hill, NC, United States.
authors.forename: Leslie H
authors.initials: LH
authors.lastname: Clark
authors.affiliation: Duke University, Division of Biostatistics Duke Cancer Institute Durham, NC, United States.
authors.forename: Gloria
authors.initials: G
authors.lastname: Broadwater
authors.affiliation: Duke University, Division of Gynecologic Oncology Durham, NC, United States.
authors.forename: Jessie
authors.initials: J
authors.lastname: Ehrisman
authors.affiliation: University of North Carolina-Chapel Hill, Division of Gynecologic Oncology Chapel Hill, NC, United States.
authors.forename: Paola
authors.initials: P
authors.lastname: Gehrig
authors.affiliation: Medical University of South Carolina, Division of Gynecologic Oncology Charleston, SC, United States.
authors.forename: Whitney
authors.initials: W
authors.lastname: Graybill
authors.affiliation: Duke University, Division of Gynecologic Oncology Durham, NC, United States.
authors.forename: Angeles
authors.initials: A
authors.lastname: Alvarez Secord
authors.affiliation: Duke University, Division of Gynecologic Oncology Durham, NC, United States.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
keywords: Chemotherapy; Disease response; Endometrial cancer; Resistance; Treatment; Tumor grade