A Cochrane review on cytotoxic chemotherapy in women with advanced, recurrent or metastatic endometrial adenocarcinoma included 14 studies, 8 of which compared 'more' with 'less' chemotherapy(n=1519). Treatment consisting of 'more' chemotherapy was associated with longer overall survival (OS) (hazard ratio (HR) 0.86; 95% confidence intervals (CI) 0.77 to 0.96; P = 0.005) and with longer progression-free survival (PFS) ( HR 0.82; 95% CI 0.74 to 0.90; n = 1526, P < 0.0001). However, serious acute toxicities were more common in women randomised to the more-intense chemotherapy regimens.
There was no evidence to suggest that any particular doublet chemotherapy was better (or worse) than any other, or that any single-agent chemotherapy was better (or worse) than another; however, data for these two comparisons were limited. There were no comparative trials of chemotherapy with endocrine therapy or best supportive care alone.
Overall the results for progression favoured more rather than less chemotherapy. The HR (Hazard Ratio) of 0.80 (95% CI 0.71 to 0.90) across trials shows a highly significant 20% relative improvement in survival with the more intense regimens compared to the less intense regimens (P = 0.0004), which suggests an improvement in the median PFS/interval of approximately 1 month. This effect is more pronounced in the group of trials that compared doxorubicin and cisplatin plus other drugs with doxorubicin and cisplatin alone with a HR of 0.64 (95% CI 0.49 to 0.82, p = 0.0004).