“Hopeless if relapsed, patient finds hope with immuno-oncology”

Dr. Kim Jae-won, a professor of obstetrics and gynecology at Seoul National University College of Medicine, one of Korea’s leading experts on gynecologic cancers, was attending the Society for Gynecologic Oncology (SGO) meeting in the United States in March this year when he had a startling experience. He was presenting the Phase III results of Gemperi (dostalimumab), an immuno-oncology drug approved for the treatment of endometrial cancer, when a white woman in her late 50s stood up to thank him during the Q&A session.

She described herself as an “endometrial cancer survivor,” and her eyes filled with tears as she thanked the researchers for “developing an immuno-oncology drug that works. The audience in the ballroom rose to their feet and gave her a standing ovation. “I could see what the new drug means to cancer patients,” said Kim, who has attended many conferences overseas, “but that scene really impressed me.”

Endometrial cancer is a cancer that develops in the endometrium, the lining of the uterus, and is a major gynecologic cancer along with cervical cancer. While the disease is serious, endometrial cancer is not difficult to treat. The five-year survival rate for endometrial cancer is 89.3%. This means that with timely surgery, 9 out of 10 patients can expect to be cured.

But it’s not a cancer to be taken lightly. Even with surgery to remove the uterus, one in four women with stage 3 or 4 disease recur. The five-year survival rate for these patients is less than 10 percent, and the median survival time is less than a year. As a result, endometrial cancer is diagnosed at a late stage (stage 3 or 4), or if it recurs, treatment is focused on prolonging life rather than curing it.

In particular, patients who have recurred often refuse to undergo treatment as they become physically and mentally exhausted from toxic chemotherapy and radiation. This is why gynecologists who operate on endometrial cancer often feel sorry for patients with recurrent cancer. However, this has changed with the advent of immuno-oncology drugs. Prof. Kim explains that even these late-stage recurrence patients have hope for a cure.

The number of gynecologic cancer patients in Korea has been increasing rapidly in recent years. According to the National Cancer Center, 23,262 patients were diagnosed with gynecological cancer in 2021, up about 33.5 percent from 17,421 in 2017. Given that the number of diagnostic tests was significantly reduced last year due to the COVID-19 pandemic, the number of patients diagnosed with the disease is expected to increase further this year. The National Cancer Center predicts that the number of endometrial cancer patients will more than double in a decade, from 7,000 in 2030 to 14,000 in 2040.

Dr. Kim graduated from Seoul National University College of Medicine and received her master’s and doctoral degrees from the same university. She became president of the Korean Society of Gynecologic Oncology this year and has been president of the Asian Society of Gynecologic Oncology since last year. We caught up with Dr. Kim to learn about the latest trends in endometrial cancer treatment. Here’s a one-on-one with Dr. Kim

-What is endometrial cancer?

“There are three types of gynecologic cancers: cervical, cervical, and ovarian. The majority of cervical cancers are endometrial cancers, which are cancers of the endometrium, the lining of the trunk of the uterus, and the remainder are uterine sarcomas, which are malignant tumors of the muscle or connective tissue. In the past, cervical cancer was the most common type of cancer, but in recent years, endometrial cancer has rapidly increased and overtaken cervical cancer. In the West, such as Europe, the proportion of endometrial cancer patients is much higher.”

-Dr. Jenkins on why there are so many endometrial cancer cases in Western Europe.

“We think it’s because there are more obese people. Mast cells stimulate the secretion of the female hormone estrogen, which stimulates the lining of the uterus and makes it more prone to cancer. This is why the incidence of endometrial cancer is linked to childbirth. This is because estrogen is not produced during pregnancy and lactation. In the past, when fertility rates were high, the incidence of endometrial cancer was low, but nowadays, when people have fewer children, the number of cases is bound to increase. Other major risk factors include heredity, early menarche and menopause, and other conditions such as diabetes.”

-Dr. Jenkins on when to suspect endometrial cancer

“If you haven’t had a period for more than a year and you have vaginal bleeding, I would suspect it. If there are no lesions on the cervix, I would do an ultrasound to see if there are any problems inside the uterus. The normal thickness of the endometrium in menopausal women is 5 to 6 millimeters, but if it’s thicker than that, we’ll do a biopsy.”

-Dr. Liu on how to prevent endometrial cancer

“There is no specific prevention. That’s why it’s important to get tested as soon as you have symptoms, such as vaginal bleeding. Many women don’t take it seriously when they have irregular bleeding, and some don’t메이저놀이터 realize it until it’s too late, in stage 4. Emphasize the importance of visiting a doctor as soon as you have symptoms. Nine out of 10 women with endometrial cancer experience menopausal vaginal bleeding.”

-What are the symptoms other than vaginal bleeding?

“If you feel pressure in your abdomen or pelvic area and have a yellowish discharge with a foul odor, you should consider the possibility of endometrial cancer.”

-Dr. Jenkins I know that endometrial cancer screening is not included in the National Cancer Screening Program. Why?

“While breast and cervical cancers have screening tests that can find and treat the tissue before it becomes cancerous, endometrial and ovarian cancers do not. For endometrial cancer, it’s hard to get a full exam because the tissue inside the uterus is removed.”

-How is it treated?

“A hysterectomy is performed. Endometrial cancer is most common in women in their 50s (36.0%), followed by those in their 60s (22.7%) and 40s (19.9%). It mainly occurs after menopause. When a woman is menopausal, she is no longer able to give birth, so she undergoes a hysterectomy. Since hysterectomy involves the removal of the entire uterus, it is less difficult than cervical cancer and is considered an easy surgery, similar to the removal of fibroids. The outcomes are good. Three-quarters of endometrial cancer cases are caught in the early stages, and the cure rate for stage 1 is over 90% with surgery. “

-I’ve noticed an increase in patients in their 20s and 30s. What should patients do if they plan to have children and become pregnant in the future?

“There are not many endometrial cancer patients of childbearing age. About one in 10 women in their 20s and 30s are treated with hormone therapy instead of hysterectomy. The idea is to slow down the progression of the disease with hormone therapy every three months. The uterus is then removed if necessary after pregnancy and childbirth.

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