Fertility saving treatment for endometrial cancer
An intrauterine device (IUD) could help preserve fertility and reduce the need for hysterectomies for women suffering from endometrial cancer.
Currently standard surgical treatment of endometrial cancer is a total hysterectomy. While surgery is safe and effective, it removes a women’s fertility. In addition, women who are elderly, obese or have other medical illness will have an increased risk of surgical complications. Less invasive methods are needed for these groups.
Our team at the Queensland Centre for Gynaecological Cancer Research has just completed the feMMe study—a phase II randomised trial with 165 endometrial cancer patients from Australia and New Zealand.
Women were on average 53 years of age, with a body mass index (BMI) 48 kg/m2 which is categorised as obese. Ninety-six patients (58%) were diagnosed with endometrial cancer and 69 (42%) patients with endometrial hyperplasia with atypia. Endometrial hyperplasia with atypia occurs when the lining of the uterus thickens, causing heavy or abnormal bleeding. It is a precursor disease to endometrial cancer which means it raises your risk of developing this cancer.
The feMMe study treated women with endometrial cancer less-invasively through the use of a hormone-releasing Intra-Uterine Device (IUD), reducing the need for surgery and preserving a women’s fertility. The results of the feMMe study were positive and have provided a much-needed option for young and overweight women who may be eligible for a non-surgical treatment option. Eighty-two per cent of women with endometrial hyperplasia with atypia and 42% of women with endometrial cancer responded to the new non-invasive treatment. We also found that there were few side effects using these new methods.
The trial also showed that the use of a weight loss regime the in addition to the IUD improved the likelihood of treatment success to a 67% response rate. In the weight-loss group, patients were asked to complete a six-month subscription to Weight Watchers, and were encouraged to lose 7% body weight in 6 months.
The feMMe results benefit women who have an unreasonably high risk of complications from endometrial cancer surgery, such as the elderly and obese, and younger women diagnosed with early stage cancer who wish to retain fertility to complete their families.
This treatment is now established and should be used in clinical practice.
While the results of the trial are positive, there is more work yet to be done. We need to focus further research efforts to find which factors can predict those who have a response versus those who did not respond to this non-invasive treatment.
The details and results of the feMMe trial were published in Gynaecologic Oncology.
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