Reevaluating Treatment for Stage III Endometrial Cancer

Data on gynecological malignancies are essential for hospital, state, and national cancer registries, enabling outcome studies that compare various treatment approaches. For stage III endometrial cancer, treatment options include radiotherapy and, more recently, chemotherapy. However, whether combining these modalities improves survival outcomes remains uncertain.

A recent phase 3 trial found that adding radiation to chemotherapy did not improve overall or recurrence-free survival in patients with locally advanced endometrial cancer compared to chemotherapy alone. In this randomized study, 813 patients with stage III or IVA endometrial cancer (median age: 60 years) were assigned to receive either chemoradiotherapy (n = 407) or chemotherapy alone (n = 406). Among them, 680 received the assigned treatment (333 in the chemoradiotherapy group and 347 in the chemotherapy group). The study population was predominantly non-Hispanic White, with 10% identifying as Black, and 97% had stage III disease.

The primary endpoint of the trial was recurrence-free survival, with overall survival also analyzed across both treatment groups. Results showed no improvement in local recurrence rates for patients receiving chemoradiotherapy compared to those receiving chemotherapy alone. Overall survival remained similar between the two groups. After a median follow-up of 112 months, the median overall survival had not been reached in either arm.

This updated analysis demonstrated that adding pelvic radiation to chemotherapy provided no benefit in recurrence-free or overall survival for patients with stage III locally advanced endometrial cancer. Additionally, no pathological or demographic factors were identified that predicted a survival advantage in the chemoradiotherapy group.

Can Low-Dose Aspirin Reduce Colorectal Cancer Recurrence?

The benefits of low-dose aspirin have been debated for years, particularly regarding its role in reducing coronary disease. However, its potential in preventing and managing colorectal cancer (CRC) has gained significant attention. A recent study found that low-dose aspirin reduced CRC recurrence by over 50% in patients whose tumors harbored mutations in the PI3K signaling pathway. These findings underscore the critical importance of upfront genomic testing for CRC patients. 

This is the first trial to demonstrate that PI3K pathway mutations predict aspirin response, significantly expanding the targetable patient population—given that approximately 30% of CRCs carry these mutations. While aspirin’s potential as a chemopreventive agent for CRC has been explored, definitive data confirming its effectiveness and its adoption in clinical practice have been lacking until now. 

The study included 626 patients (median age: 66 years; 52% women) with stage II–III colon cancer (67%) or stage I–III rectal cancer (33%) across 33 hospitals in Sweden, Denmark, Finland, and Norway. Patients were stratified based on specific PI3K pathway alterations and randomly assigned to receive either aspirin (160 mg daily) or a placebo for three years. 

The primary outcome was CRC recurrence, with disease-free survival as a secondary endpoint. In patients with PIK3CA mutations, aspirin reduced the risk of recurrence by 51%, with a three-year recurrence rate of 7.7% in the aspirin group compared to 14.1% in the placebo group. The benefit of aspirin was consistent across all subgroups, including men and women, those with colon or rectal cancer, patients who received neoadjuvant or adjuvant treatment, and those with stage I, II, or III disease. 

This study reinforces the need to integrate genomic marker data into clinical registries to guide personalized treatment strategies that can effectively reduce cancer recurrence.