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

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

Describing herself as an “endometrial cancer survivor,” she tearfully 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 gynaecological cancer along with cervical cancer. Although it is a serious disease, endometrial cancer is not difficult to treat. The five-year survival rate for endometrial cancer is 89.3 per cent. 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 will recur. The five-year survival rate for these patients is less than 10 per cent, and the median survival time is no more than a year, so 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 radiotherapy. This is why gynaecologists who operate on endometrial cancer often feel sorry for patients with recurrent cancer. However, this has changed with the advent of immuno-oncology drugs. The introduction of immuno-oncology drugs has opened up hope for these late-stage recurrence patients, Kim says.

The number of gynaecological cancer patients in Korea has been increasing rapidly in recent years. According to the National Cancer Centre, 23,262 patients were diagnosed with gynaecological 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 number of endometrial cancer patients is expected to more than double in a decade, from 7,000 in 2030 to 14,000 in 2040, according to the National Cancer Centre.

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 Gynaecological Oncology this year and has been president of the Asian Society of Gynaecological Oncology since last year. We caught up with Professor Kim to learn about the latest trends in endometrial cancer treatment. Here’s a one-on-one with Professor Kim.

-What is endometrial cancer?

“There are three types of gynaecological 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 tumours of the muscle or connective tissue. In the past, cervical cancer was the most common type of cancer, but recently endometrial cancer has been growing rapidly and has 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.

“It’s probably due to the high prevalence of obesity. Mast cells stimulate the release 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, with 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.”

-When to suspect endometrial cancer

“If you haven’t had your 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 millimetres, 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’t find out until it’s too late, in stage 4. Emphasise the importance of visiting a doctor as soon as you have symptoms. Nine out of 10 women 스포츠토토with 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 foul-smelling, yellowish discharge, you should consider the possibility of endometrial cancer.”

-Dr. K. I know that screening for endometrial cancer is not included in the National Cancer Screening Programme. Why?

“While breast and cervical cancers have screening tests that can find and treat the tissue before it becomes cancerous, this is not the case for endometrial and ovarian cancer. Endometrial cancer requires removing tissue from the inside of the uterus, so it’s hard to do a full exam.”

-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 per cent with surgery. “

-I’ve heard that the number of patients in their 20s and 30s is increasing. 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 hormonal treatment every three months. After pregnancy and childbirth, the uterus is removed if necessary.

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