Vintage ASCO.

Top Line: What are journals supposed to publish in the ASCO aftermath?
The Study: Uh, final manuscripts from previous ASCO abstracts, of course. If you can remember 2017, the initial abstract of GOG 258 helped nobody decide what the best approach is for high-risk endometrial cancer. Again, patients with any stage III/IVA disease or stage I/II serous or clear cell with positive peritoneal washings were enrolled. Ultimately, though, the large majority had endometrioid histology with nodal metastases. They received either [1] adjuvant 45 Gy radiation with concurrent cisplatin followed by carbo/taxol x 4 or [2] adjuvant carbo/taxol x 6. The final manuscript now reports recurrence-free survival at 5 years is still not different between arms at 58-59%. Instead, differences came in the form of toxicity and patterns of failure. Chemo alone had higher G3+ toxicity (58→ 63%) and double the rate of G4+ toxicity (14 → 30%). Chemo alone also resulted in higher rates of vaginal (2 → 7%) and pelvic/para-aortic (11 → 20%) recurrence but a lower rate of distant failure (27 → 21%). Compared to PORTEC-3, GOG 258 included more advanced nodal disease but comparable proportions of non-endometrioid histology. Meaning the “high-risk” in this trial was higher than the “high-risk” in PORTEC-3. In that context, GOG 258 shows that even though radiation reduces nodal and vaginal failures, that reduction isn’t enough to negate high rates of distant failure.
Bottom Line: The addition of pelvis radiation to chemo alone doesn’t appear to improve recurrence-free survival among women with high-risk (read: high nodal burden) endometrial cancer. | Matei, N Engl J Med 2019


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