Again, there is about a 40% response rate, there is very few complete responses, and the overall responding time frame is about seven months, so all these patient’s begin to grow, even though they have had a complete response to Adriamycin and cisplatinum. Recently, Taxol has been looked at, Taxol has a 20% response rate, it is currently being looked at in a SWOG protocol where they are utilizing carboplatinum and Taxol, substituting carbo for the cisplatin because it’s easier tolerated, against Taxol, and this seems to be a promising chemotherapy option, simply because Adriamycin is not well tolerated in the elderly and it’s a very difficult regimen to get patient’s through. Part of the problem with the GOG study was you were taking your best medical candidates to put them on the Adriamycin, your more sicker patient candidate who had heart disease and hypertension couldn’t qualify to get onto the Adriamycin.
Lastly is hormonal therapy, approximately one-third of patient’s with advanced or recurrent endometrial cancer will respond to progesterones, well differentiated tumors tend to have better response rate than undifferentiated tumors. Unfortunately, the tumors that tend to metastasize or become recurrent are the undifferentiated tumors and they have less of a response to progesterone, but it is recommended for patient’s who are not chemotherapy candidates who have received chemotherapy and are no longer chemotherapy candidates, about a third of them will respond to progestins and that includes patient’s that do not have hormonal receptors and they really don’t understand that mechanism. And lastly, they are looking at combining tamoxifen with progesterone, the reason for tamoxifen although it’s in the back of our mind that it causes endometrial cancer, but what tamoxifen does in recurrent or advanced endometrial cancer is produce progesterone receptors and so it is felt that it aids in the use of using Megace or progesterone agents in getting a hormonal response. There are some trials out there now looking at tamoxifen combined with progesterone therapy. Because endometrial cancer usually presents as stage I disease, it’s a very favorable cancer, usually surgery combined with postoperative radiation if needed, gets very long term survival and very good quality survival, our survival rates can be as high as 90% and well differentiated tumors and still even in stage II tumors which are advanced tumors, we are still getting five year 50% survival. So overall, it is a favorable tumor we can work with. Unfortunately, if you get a tumor that’s well advanced or recurrent, it is a very difficult tumor to irradiate because it’s not chemo sensitive and only a third will respond to progesterone agents.