The female genital tract is hormonally responsive, and consequently some
tumors, which arise within in it, may be treated at least in part, with hormonal manipulation. The range of responses in clinical trials and case reports will be reviewed. Many of these diseases are too rare for clinical trial testing, and in some cases evidence is anecdotal at best. Recurrences of
ovarian cancer have been treated with
tamoxifen and megesterol
acetate with variable response rates from 0 to 56%. The favorable toxicity profile of
aromatase inhibitors led to trials of these agents for the treatment of relapsed
epithelial ovarian cancer. These agents have proved tolerable with minor response rates but a significant disease stabilization rate, which may be prolonged in a minority of cases. It is unclear if these responses may be predicted by
estrogen receptor expression or
aromatase expression.
Anastrazole has also been tried in combination with an EGFR receptor-inhibitor, again showing minor responses but possibly an increase in TTT in some patients.
Granulosa cell tumors of the ovary are rare, hormonally sensitive
tumors, with reported responses to a variety of hormonal manipulations, including
aromatase inhibition. In addition, combined endocrine blockade, including
aromatase inhibition, has been tried with reports of success.
Endometrial cancers, particularly type I lesions, are often treated with hormonal manipulation, most commonly with
progestins, but also with
antiestrogens such as
tamoxifen. A trial of
aromatase inhibition in the treatment of recurrent
endometrial cancer showed minimal responses.
Endometrial stromal sarcoma, an uncommon uterine
malignancy, has shown response to hormonal treatments, with multiple case reports of efficacy of
aromatase inhibition. Despite the rarity of some of these
tumor types, rare
tumor study groups, such as within the Gynecologic Oncology Group, should make an effort to prospectively define the utility of these treatments.