Neoadjuvant therapy of endometrial cancer with the aromatase inhibitor letrozole: endocrine and clinical effects

Eur J Obstet Gynecol Reprod Biol. 2002 Nov 15;105(2):161-5. doi: 10.1016/s0301-2115(02)00147-1.

Abstract

Objective: To investigate the short-term hormonal and clinical effects of the aromatase inhibitor letrozole (Femara) in patients with endometrial cancer.

Materials and methods: Ten previously untreated, post-menopausal patients (mean age 59 years) with endometrial cancer, predominantly stage I disease, received letrozole 2.5mg per day for 14 days before surgery. Clinical, sonographic, morphologic, cytologic, and hormonal-metabolic parameters (blood estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), glucose, and cholesterol by radioimmunoassay, enzyme immune assay, or enzyme-colorimetric methods; tumor progesterone receptors by ligand-binding assay; and aromatase activity by 3H-water release assay) were evaluated before and after treatment.

Results: Treatment was well-tolerated in all patients. In two patients, pain relief in the lower part of the belly and/or decrease in intensity of uterine discharge was reported. In the three cases, substantial decreases in endometrial M-echo (ultrasound) signal were noted; the mean value of this parameter after treatment was 31.1% lower than before treatment. Blood estradiol concentration decreased by an average of 37.8% after letrozole therapy, and tumor progesterone receptor levels and aromatase activity decreased by 34.4 and 17.5%, respectively. Treatment with letrozole did not influence surgery.

Conclusions: These data show that short-term treatment with letrozole in the neoadjuvant setting resulted in some positive clinical changes. Longer-term and larger-scale trials of neoadjuvant letrozole in endometrial cancer are warranted.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aromatase Inhibitors*
  • Endometrial Neoplasms / diagnostic imaging
  • Endometrial Neoplasms / pathology
  • Endometrial Neoplasms / therapy*
  • Enzyme Inhibitors / therapeutic use*
  • Estradiol / blood
  • Female
  • Follicle Stimulating Hormone / blood
  • Humans
  • Letrozole
  • Luteinizing Hormone / blood
  • Middle Aged
  • Neoadjuvant Therapy*
  • Neoplasm Staging
  • Nitriles / administration & dosage
  • Nitriles / adverse effects
  • Nitriles / therapeutic use*
  • Postmenopause
  • Receptors, Progesterone / analysis
  • Treatment Outcome*
  • Triazoles / administration & dosage
  • Triazoles / adverse effects
  • Triazoles / therapeutic use*
  • Ultrasonography

Substances

  • Aromatase Inhibitors
  • Enzyme Inhibitors
  • Nitriles
  • Receptors, Progesterone
  • Triazoles
  • Estradiol
  • Letrozole
  • Luteinizing Hormone
  • Follicle Stimulating Hormone