Endometrial cancer treatment and outcomes in Argentina: ECHOS-A real-world study

Abstract

Objective: Real-world data for patients with endometrial cancer (EC) are limited, particularly in Latin America. We present treatment pattern findings from ECHOS-A - Endometrial Cancer Health Outcomes Study in Argentina.

Materials and methods: A retrospective study using clinical data from privately insured patients with EC diagnosed from 2010 to 2019. Index (diagnosis proxy) was first date of an EC-related health term or treatment. Demographics, clinical characteristics, and FIGO staging were described. Disease progression and survival were assessed until study end, loss to follow-up, or death.

Results: Of 805 patients with EC, 77.4 % (n = 623/805) received any treatment and 22.6 % (n = 182/805) received none. Among those treated, 31.8 % (n = 198/623) had first-line (1L) systemic therapy, and 45.5 % (n = 90/198) proceeded to second-line (2L) therapy. Mean follow-up was 33.6 (SD 31.8) months. Of those receiving any treatment, 87.3 % (n = 544/623) had FIGO stage data (I, 62.9 %; II, 18.6 %; III, 13.6 %; IV, 5.0 %). Treatment by class in 1L and 2L, respectively, were platinum chemotherapy, 73.7 %, 36.7 %; non-platinum chemotherapy, 73.7 %, 62.2 %; immunotherapy, 1.0 %, 11.1 %; hormone therapy, 17.7 %, 26.7 %. Carboplatin/paclitaxel was the most frequent 1L (52.5 %) and 2L (14.4 %) regimen. Mean time to progression was 14.1 (SD 16.3) and 8.8 (SD 8.3) months in 1L and 2L, respectively. Adjusted 1- to 5-year risk of progression/death was 46.5-77.5 % and 65.0-86.2 % in 1L and 2L, respectively.

Conclusions: Approximately one-quarter of patients with EC received no treatment, and approximately two-thirds were not treated with 1L systemic therapy. Efforts to better understand the reasons for these treatment patterns are crucial for improving patient outcomes.

Keywords: Argentina; Endometrial cancer; Latin America; Overall survival; Progression-free survival; Real world.

Graphical abstract

Fig. 1

Study disposition and therapies received in the first- and second-line settings between 2010 and 2019. Systemic therapy: hormone therapy, chemotherapy, or immunotherapy. *Patients could receive more than one therapeutic class in the same line of therapy. ^†Patients can appear in only one combination group. 1L, first line; 2L, second line; EC, endometrial cancer.

Fig. 2

Endometrial cancer treatment by FIGO stage. Missing: overall, 24.2 % (n = 195); any treatment, 12.7 % (n = 79); systemic therapy, 15.7 % (n = 31). *FIGO staging classifications are based on surgical staging, including an assessment of the extent of myometrial invasion, and local and distant metastases, which are key prognostic factors in endometrial cancer. The classifications are divided into four stages: stage I (tumor confined to the corpus uteri); stage II (tumor invades cervical stroma but does not extend beyond the uterus); stage III (local and/or regional spread of the tumor); and stage IV (tumor invades bladder and/or bowel mucosa, and/or distant metastases) (Morice et al., 2016). ^†Includes surgery, radiotherapy, or any systemic therapy. FIGO, International Federation of Gynecology and Obstetrics.

Fig. 3

Kaplan–Meier curves. (A): Estimated progression-free survival following first-line systemic therapy. The three patients who experienced progression on the day of end of first-line therapy were not included in this analysis. (B): Estimated progression-free survival following second-line systemic therapy. The one patient who experienced progression on the day of end of second-line therapy was not included in this analysis. (C): Overall survival. Adjusted median represents patients who experienced progression, including censored time by loss to follow-up. *Death was included as progression. CI, confidence interval.