A 68-year-old woman develops symptomatic pelvic recurrence of grade 1 endometrioid carcinoma three years after surgery and vault radiotherapy. The recurrence is unresectable and she declines further radiation. Her tumour is strongly estrogen receptor positive. Which systemic therapy is the most appropriate first choice?
- A Bevacizumab
- B Carboplatin plus paclitaxel
- C Megestrol acetate ✓
- D Pembrolizumab
Correct answer: C. Megestrol acetate
Explanation
Well-differentiated, estrogen receptor positive endometrioid carcinoma retains hormonal responsiveness, and progestational agents such as megestrol acetate produce objective responses in roughly 20 to 25 percent of such patients with low toxicity, making them reasonable first-line therapy for indolent recurrence. Chemotherapy is reserved for aggressive or progesterone-refractory disease, pembrolizumab requires mismatch repair deficiency, and bevacizumab is not standard first-line in this setting. Receptor status and grade drive the hormonal choice.
Reference: Williams Gynecology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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