An intrauterine device, or IUD, that releases the hormone levonorgestrel appears to be an effective treatment for endometrial precancer and early-stage endometrial cancer, according to new study results presented by Andreas Obermair, MD, at the Society of Gynecologic Oncology (SGO) 2021 Virtual Annual Meeting on Women’s Cancer (Abstract ID 11486).
Six months after insertion of the hormonal IUD, biopsy results showed no signs of cancer or precancer in two-thirds of 165 women with stage I endometrial cancer or atypical endometrial hyperplasia, the investigators reported. Atypical endometrial hyperplasia is a precancerous condition of the endometrium.
“Our results are encouraging, and further research is warranted using a longer treatment duration,” said lead study author Dr. Obermair, Professor, University of Queensland Faculty of Medicine, Brisbane, Australia.
Andreas Obermair, MD
Rates of Response
The biopsy-proven treatment response, or complete pathologic response, varied by disease. While 82% of women with precancer (79 of 96) had a complete response, only 43% of women with cancer (30 of 69) responded completely.
“This difference in response rates is what previous studies with much smaller case numbers reported, and it is not surprising,” said Dr. Obermair. “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, and 47 IUD recipients also participated in a weight loss program. All study participants had obesity, a known risk factor for endometrial cancer.
At 6 months, the complete pathologic response ranged from 57% for metformin treatment to 67% for weight loss, reported Dr. Obermair. He cautioned that a complete pathologic response at 6 months does not always translate to a cure because recurrences are possible.
Although the levonorgestrel IUD is available as a contraceptive, Dr. Obermair said its use as an endometrial cancer treatment is still experimental. If approved, 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.
