Chemotherapy for Endometrial Cancer

Chemotherapy (Chemo) is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. When recommended for endometrial cancer treatment, chemotherapy usually is given after surgery. Chemotherapy is also considered if the endometrial cancer returns after the initial treatment.

Chemo drugs used to treat endometrial cancer

Chemo drugs used to treat endometrial cancer may include:

• Paclitaxel (Taxol^®)
• Carboplatin
• Cisplatin
• Doxorubicin (Adriamycin^®) or liposomal doxorubicin (Doxil^®)
• Bevacizumab (Avastin)
• Docetaxel (Taxotere^®)
• Gemcitabine

Most often, 2 or more drugs are combined for treatment. The most common combinations include carboplatin/paclitaxel and cisplatin/doxorubicin.      

For uterine carcinosarcoma, the chemo drug ifosfamide (Ifex^®) might be used, either alone or along with either cisplatin or paclitaxel.     

When and how are chemo drugs used to treat endometrial cancer

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or a combination of different drugs given at the same time.

The goal of chemotherapy is to destroy cancer cells left after surgery or to shrink the cancer and slow the tumor's growth if it comes back or has spread to other parts of the body. Although chemotherapy can be given orally, most drugs used to treat endometrial cancer are given by IV. IV chemotherapy is either injected directly into a vein or through a catheter, which is a thin tube inserted into a vein.

Sometimes chemo is given for a few cycles, followed by radiation. Then chemo is given again. This is called sandwich therapy. Another treatment option is to give chemo with radiation (called chemoradiation). The chemo can help the radiation work better, but it can be harder on the patient because the combination causes more side effects. The chemo given in this situation is usually cisplatin.

Side effects of chemotherapy for endometrial cancer

These drugs kill endometrial cancer cells but can also damage some normal cells, which in turn causes side effects. Side effects of chemotherapy depend on the drugs used, the amount taken, and how long treatment is given. Common side effects include:

• Nausea and vomiting
• Loss of appetite
• Mouth sores
• Neuropathy
• Hair loss
• Rarely, some drugs cause some hearing loss

Also, most chemo drugs can damage the blood-producing cells of the bone marrow. This can result in low blood cell counts, such as:

• Low white blood cells, which increases the risk of infection
• Low platelet counts, which can cause bleeding or bruising after minor cuts or injuries
• Low red blood cells (anemia), which can cause problems like fatigue and shortness of breath

Heart damage

Most of the side effects of chemotherapy get better over time when treatment ends, but some can last a long time. For instance, doxorubicin can damage the heart muscle over time. The chance of heart damage goes up as the total dose of the drug goes up, so doctors limit how much doxorubicin a person will get.

Kidney damage

Cisplatin can cause kidney damage, so you'll be given lots of IV fluids before and after chemo to help protect the kidneys. Both cisplatin and paclitaxel can cause nerve damage (called neuropathy). This can lead to numbness, tingling, or even pain in the hands and feet.

Ifosfamide can injure the lining of the bladder, causing it to bleed (called hemorrhagic cystitis). To prevent this, you might be given large amounts of IV fluids and a drug called mesna along with the chemo. 

Infertility

Other possible side effects of chemotherapy for endometrial cancer include infertility (the inability to become pregnant in the future) and early menopause, if the patient has not already had a hysterectomy. Talk with your doctor before treatment starts if you want to save your fertility.

Before starting chemotherapy, be sure to discuss the drugs and their possible side effects with your health care team.

If you have side effects while getting chemotherapy, remember that there are ways to prevent or treat most of them. For instance, there are many drugs that can help prevent or reduce nausea and vomiting. Be sure to tell your health care team about any side effects you have. Treating them right away can often keep them from getting worse.