Hormonal IUD Shows Promise as an Effective Treatment for Early Endometrial Cancer or Precancer

According to study results presented at the SGO meeting, biopsies showed no signs of cancer or precancer in two-thirds of 165 women with stage I endometrial cancer or atypical endometrial hyperplasia, 6 months after insertion of the hormonal IUD.

An intrauterine device­ (IUD) that releases the hormone levonorgestrel has shown promise as an effective treatment for endometrial precancer and early-stage endometrial cancer. Results of the study are being presented at the Society of Gynecologic Oncology (SGO) 2021 Virtual Annual Meeting on Women’s Cancer.

Endometrial is the most common gynecologic cancer. According to the American Cancer Society, an estimated 60,000 new cases will be diagnosed in 2021 in the United States.

The most common first treatment of endometrial cancer is a total hysterectomy and removal of both ovaries.

According to the study results being presented at the SGO meeting, biopsies showed no signs of cancer or precancer in two-thirds of 165 women with stage I endometrial cancer or atypical endometrial hyperplasia, 6 months after insertion of the hormonal IUD. Atypical endometrial hyperplasia is a precancerous condition of the lining of the uterus.

According lead study author Andreas Obermair, MD, professor, University of Queensland Faculty of Medicine, Brisbane, Australia, further research is warranted using a longer treatment duration.

The complete pathological response varied by disease. Although 82% of the 96 studied women with precancer had a complete response, only 43% of the 69 women with cancer responded completely.

“This difference in response rates is what previous studies with much smaller case numbers reported, and it is not surprising,” Obermair said. “As cells move from healthy to cancer, they lose capability to respond to levonorgestrel.”

The investigators also studied response rates for women who received treatment in addition to the IUD. Forty-seven patients received IUD plus metformin, which has potential anti-cancer activity, and 47 IUD recipients also participated in a weight loss program. All study participants had obesity, a known risk factor for endometrial cancer.

At six months, the complete pathological response ranged from 57% for metformin treatment to 67% for weight loss, Obermair reported. He cautioned that a complete pathological response at 6 months does not always translate to a cure because recurrences are possible.

Although the levonorgestrel IUD is available as a contraceptive, Obermair said its use as an endometrial cancer treatment is still experimental. If approved by the FDA, this IUD would be an option for women who wish to preserve fertility or cannot have an operation because of a high risk for complications.

REFERENCE

Hormonal IUD shows promise as nonsurgical treatment for early endometrial cancer or precancer [news release]. Chicago, IL; March 21, 2021: SGO. [email]