Treatment of advanced endometrial adenocarcinoma with a combined cytotoxic therapy. Predictive value of cytosol estrogen and progestin receptor levels.
Twenty patients with advanced or recurrent endometrial adenocarcinoma were treated with combination chemotherapy consisting of Adriamycin, cyclophosphamide, 5-fluorouracil, and vincristine at three-week intervals. A minimum of four treatment courses was given in each case. There were five total and five partial responses (50% favorable response rate); progression of the disease was evident in seven cases (35%). Lung metastases responded significantly better (P < 0.01) than other lesions: seven out of nine lung metastases showed an objective remission, whereas only two out of 11 tumors in pelvic, abdominal, or retroperitoneal space responded. The response rate did not correlate with histologic grade of tumor differentiation, or the performance state and age of the patient. Cytosol estrogen and progestin receptor levels were measured in 15 cases from the carcinomatous endometrial tissue prior to therapy. Ten patients with low receptor values (estrogen and/or progestin receptors below 30 fmol/mg cytosol protein) had a significantly (P < 0.025) greater response rate (70%) than did patients with higher receptor values (both receptors above 30 fmol/mg protein, response rate 20%). Determination of only one of the two receptors did not differentiate the patients equally well, although the response rate tended to be better (0.05 < P < 0.1) in patients with a low level of either estrogen or progestin receptor (67% response rate) when compared with a 33% response rate in patients with a high level of the corresponding receptor. Our results suggest that the measurement of cytosol steroid hormone receptors has the potential to serve as a suitable indicator for selection of endocrine or nonhormonal chemotherapy for patients with advanced endometrial adenocarcinoma.