Chemotherapy for Uterine Cancer

Chemotherapy is a form of cancer treatment that uses drugs to kill or slow down the growth of cancer cells in the body. It is prescribed to treat a variety of cancers, including uterine cancer. Chemotherapy for uterine cancer may be prescribed before, after, or in combination with other forms of treatment, depending on the type of cancer and the extent of its spread.

Most cases of uterine cancer can be broadly classified as either endometrial (or uterine lining) cancers or uterine sarcomas. The kind of chemotherapy prescribed depends on which one of these two subtypes of uterine cancer the diagnosis falls under.

Endometrial cancer, also known as uterine lining cancer, is a subtype of uterine cancer that arises from the inner lining of the uterus. Approximately 90% of all uterine cancers are endometrial cancers. Chemotherapy is most commonly prescribed for the treatment of stage 3 or 4 endometrial cancer that has metastasized to regions of the body outside the uterus. In most cases, it is administered after surgery to reduce the chance of recurrence. Such a practice is known as adjuvant chemotherapy. Sometimes, surgery is not an option for the treatment of endometrial cancer, such as when the tumour is either too large or too close to vital organs. In such cases, chemotherapy may be prescribed as the first line of treatment instead.

For the treatment of advanced or recurrent endometrial cancer, chemotherapy may be prescribed in combination with immunotherapy. For instance, immunotherapeutics such as pembrolizumab or dostarlimab may be given alongside the chemotherapy drugs carboplatin and paclitaxel.

Uterine sarcoma is a more aggressive subtype of uterine cancer that arises from the muscles of the uterus or other supporting tissues. Approximately 3-7% of all uterine cancers are uterine sarcomas. Uterine sarcomas can be further classified into one of four subtypes:

• Uterine leiomyosarcoma
• Undifferentiated sarcoma
• Endometrial stromal sarcoma
• Adenosarcoma

Chemotherapy prescriptions for the treatment of uterine sarcoma further varies based on the uterine sarcoma subtype.

Chemotherapy for uterine leiomyosarcoma and undifferentiated sarcoma

Uterine leiomyosarcomas are uterine sarcomas that originate in the smooth muscle lining of the uterus (myometrium). Undifferentiated sarcomas of the uterus are aggressive cancers that originate in the mesenchymal cells of the uterus. Although patients are often diagnosed early, most cases of uterine leiomyosarcomas and undifferentiated sarcomas have a poor prognosis. Chemotherapy for the treatment of these uterine sarcoma subtypes is typically prescribed as adjuvant chemotherapy. The most common regiments for such cases are doxorubicin-based and gemcitabine/docetaxel-based regimens.

Chemotherapy for endometrial stromal sarcoma

Endometrial stromal sarcoma (ESS) arises from inside the endometrium,in tissue known as the stroma. It is the second most common subtype of uterine sarcoma. Both low and high grade ESS have a high rate of recurrence and do not respond well to chemotherapy. Therefore, chemotherapy is typically only prescribed for the treatment of stage 3 and 4 ESS when other forms of treatment have proven ineffective. It may also be prescribed for cases where the patient cannot undergo surgery.

Chemotherapy for the treatment of uterine adenosarcoma

Uterine adenosarcomas account for less than 10% of all uterine sarcomas. This subtype is characterised by a mix of cancerous and non-cancerous cells from different types of tissues. For the treatment of late stage, recurrent or metastatic uterine adenosarcomas, chemotherapy with doxorubicin-based regimens and gemcitabine/docetaxel, trabectedin or platinum-based regimens is commonly prescribed. However, given the rarity of this subtype, clinical evidence supporting the use of adjuvant chemotherapy in the treatment of uterine adenosarcomas is lacking.

Uterine carcinosarcoma, also known as malignant mixed Müllerian tumour, is a rare and aggressive subtype of uterine cancer that exhibits features of both endometrial carcinoma and sarcoma. Less than 5% of all uterine cancers are uterine carcinosarcomas. Adjuvant chemotherapy with cisplatin/ifosfamide, ifosfamide/paclitaxel and paclitaxel/carboplatin regimens have proven to be effective. The concurrent administration of both chemotherapy and radiotherapy, known as multimodal therapy, has also been shown to be effective.

For uterine cancer treatment, chemotherapy is most commonly delivered as an intravenous (IV) infusion into either your arm or chest. It may also be given orally, in pill or capsule form. It is typically administered cyclically, with each cycle of therapy followed by time off medication. This allows the patient’s body to recuperate from side effects. Depending on where you live, you may be able to receive chemotherapy:

• In a hospital
• At the doctor’s office
• In an outpatient chemotherapy unit
• At home

• Paclitaxel
• Carboplatin
• Cisplatin
• Doxorubicin
• Bevacizumab
• Docetaxel
• Gemcitabine

Carboplatin/paclitaxel and cisplatin/doxorubicin are amongst the most common chemotherapy drug combinations for uterine cancer treatment. For uterine carcinosarcoma, ifosfamide may be prescribed with or without either cisplatin or paclitaxel.

Common general side effects of chemotherapy include

• Loss of appetite
• Nausea and vomiting
• Hair loss
• Neuropathy
• Mouth sores

Some chemotherapy drugs may also cause more specific side effects. For instance, cisplatin may damage the kidneys and doxorubicin can affect heart muscles when taken for prolonged periods of time. Chemotherapy drugs may also deplete your platelet, red blood cell or white blood cell count, leading to an increase in risk of bleeding or bruising, fatigue or infection.

The nature and severity of chemotherapy-induced side effects varies significantly from person to person. Speak to your doctor for advice on managing potential side effects specific to your treatment and know when to seek medical attention.