A 58-year-old woman develops pulmonary metastases four years after surgery for FIGO stage IB grade 1 endometrioid adenocarcinoma. Biopsy of a lung lesion confirms metastatic grade 1 endometrioid carcinoma, strongly estrogen and progesterone receptor positive. She is asymptomatic with indolent disease on imaging. What is the most appropriate first-line systemic treatment?
- A Carboplatin plus paclitaxel chemotherapy
- B Pembrolizumab monotherapy
- C High-dose oral medroxyprogesterone acetate or megestrol acetate ✓
- D Whole abdominal radiotherapy
Correct answer: C. High-dose oral medroxyprogesterone acetate or megestrol acetate
Explanation
Low-grade, hormone receptor positive, indolent metastatic endometrioid carcinoma responds to progestin therapy, with response rates around 25 to 30 percent concentrated in well-differentiated, ER and PR positive tumours, making it the preferred initial systemic option in an asymptomatic patient. Platinum taxane chemotherapy is reserved for symptomatic or rapidly progressive disease. Pembrolizumab requires dMMR or MSI-high status, and radiotherapy has no role for diffuse pulmonary metastases.
Reference: Berek and Hacker's Gynecologic Oncology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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