What's New in Endometrial Cancer Research?

Research on endometrial cancer prevention, early detection, and treatment is being done in medical centers around the world.

Endometrial cancer is usually found early, when it's small and easiest to treat. But advanced endometrial is less common and has been hard to study well. Most experts agree that treatment in a clinical trial should be considered for any type or stage of endometrial cancer. This way women can get the best treatment available now and may also get the treatments that are thought to be even better. Many of the new and promising treatments discussed here are only available in clinical trials.

Gene changes

For years we have known that damaged or defective DNA (DNA mutations) can change key genes that control cell growth. If these genes are damaged, out-of-control growth may result in cancer. Scientists are learning more about how certain genes called oncogenes and tumor suppressor genes control cell growth and how changes in these genes cause normal endometrial cells to become cancer.

Sometimes, endometrial cancer and colon cancer may seem to “run in a family.” We now know that some of these families have a higher risk for these cancers because they have an inherited defect in certain genes that normally help repair damage to DNA. If these repair enzymes aren't working properly, damage to DNA is more likely to persist and cause cancer.

DNA repair defects like this have also been found in endometrial cancer cells from women who haven't inherited them.

One of the normal genes responsible for suppressing tumor growth, called PTEN, is often abnormal in endometrial cancers. And we know that endometrial cancers without other tumor suppressor genes (or with inactive ones), like the KRAS and the TP53 gene, tend to be more likely to come back after initial treatment. Tests for these and other DNA changes may someday be used to help predict how fast the cancer might grow and spread. This will help doctors choose the best treatment for each woman with this disease.

Early detection

Studies are looking for ways to find endometrial cancer early -- before a woman has symptoms. Researchers are looking for DNA changes in endometrial cancer cells. Tests for these changes may someday help find endometrial cancers early.

Prevention

As doctors have learned more about the risk factors for endometrial cancer, they've begun looking for ways to help prevent it. For instance, being overweight is known to put a woman at higher risk. Studies are being done to find out if these women can benefit from prevention therapies. One study is looking at whether routine screening with endometrial biopsies might be useful in finding cell changes so they can be treated before they become cancer. Another is looking at whether a hormone-releasing IUD might help prevent endometrial cancer in these women.

Hormone therapy and a diabetes drug called metformin are also being studied for endometrial cancer prevention. These are discussed below.

New drug treatments

New drugs, new combinations of drugs, chemotherapy drugs, immunotherapies, and targeted therapies are being researched for use in women with advanced endometrial cancer. The use of chemotherapy, with or without radiation after surgery is also being studied.

Metformin

Metformin is a drug used to help control blood sugar in people with diabetes. Studies have found that diabetic women with endometrial pre-cancer and endometrial cancer who are taking metformin have better outcomes compared to women not on metformin. This has led to current clinical trials looking at whether metformin might be used to help prevent endometrial cancer and how it might to help treat women with advanced cancer. It might even be a useful treatment option for women who still want to become pregnant.

Targeted therapy

Researchers have developed drugs that target the gene and protein changes found in cancer cells. These targeted drugs are used to treat many kinds of cancer, and studies are now looking at how they might be used for endometrial cancer. Some studies are looking at new targeted therapies, too, and how to use targeted therapy along with other treatments.

Hormone therapy 

Hormone therapy to treat endometrial cancer has often involved progestins, but drugs that affect estrogen may also be helpful. Studies are looking at how to best use hormone therapy to treat all stages of endometrial cancer. Some studies are trying to find out if hormone therapy might help prevent this cancer, too.

Immunotherapy

An exciting new area of research is the use of immunotherapy to treat endometrial cancer. This is treatment that uses the body’s own immune system to fight cancer.

The immune system uses certain proteins to "see" and attack foreign cells while leaving normal cells alone. Studies have found that some endometrial cancer cells use these proteins to keep from being attacked by the immune system. As researchers learn more about this, they've begun testing drugs that focus on these cell changes to help the immune system attack the cancer cells.

Surgery

Surgery for endometrial cancer usually involves removing the uterus, cervix, ovaries, and fallopian tubes. Studies are comparing different ways to do this surgery, for instance, open vs. laparoscopic surgery and laparoscopic vs. robot-assisted surgery, to see if any one method is better that others.

Studies are also looking at outcomes when the ovaries are left in place. This keeps the woman from going into menopause and having the problems that come with it. It's most important in younger women with endometrial cancer.