Prospective multicenter randomized intermediate biomarker study of oral contraceptive versus Depo-Provera for prevention of endometrial cancer in women with Lynch syndrome

Karen H. Lu, David S. Loose, Melinda S. Yates, Graciela M. Nogueras-Gonzalez, Mark F. Munsell, Lee May Chen, Henry T. Lynch, Terri Cornelison, Stephanie Boyd-Rogers, Mary Rubin, Molly S. Daniels, Peggy Conrad, Andrea Milbourne, David M. Gershenson, Russell R. Broaddus

Research output: Contribution to journalArticle

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Abstract

Women with Lynch syndrome have a 40% to 60% lifetime risk for developing endometrial cancer, a cancer associated with estrogen imbalance. The molecular basis for endometrial-specific tumorigenesis is unclear. Progestins inhibit estrogen-driven proliferation, and epidemiologic studies have shown that progestin-containing oral contraceptives (OCP) reduce the risk of endometrial cancer by 50% in women at general population risk. It is unknown whether they are effective in women with Lynch syndrome. Asymptomatic women ages 25 to 50 with Lynch syndrome were randomized to receive the progestin compounds Depo-Provera (depo-MPA) or OCP for three months. An endometrial biopsy and transvaginal ultrasound were conducted before and after treatment. Endometrial proliferation was evaluated as the primary endpoint. Histology and a panel of surrogate endpoint biomarkers were evaluated for each endometrial biopsy as secondary endpoints. A total of 51 women were enrolled, and 46 completed treatment. Two of the 51 women had complex hyperplasia with atypia at the baseline endometrial biopsy and were excluded from the study. Overall, both depo-MPA and OCP induced a dramatic decrease in endometrial epithelial proliferation and microscopic changes in the endometrium characteristic of progestin action. Transvaginal ultrasound measurement of endometrial stripe was not a useful measure of endometrial response or baseline hyperplasia. These results show that women with Lynch syndrome do show an endometrial response to short-term exogenous progestins, suggesting that OCP and depo-MPA may be reasonable chemopreventive agents in this high-risk patient population.

Original languageEnglish
Pages (from-to)774-781
Number of pages8
JournalCancer Prevention Research
Volume6
Issue number8
DOIs
StatePublished - Aug 2013

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Hereditary Nonpolyposis Colorectal Neoplasms
Medroxyprogesterone Acetate
Endometrial Neoplasms
Oral Contraceptives
Biomarkers
Progestins
Biopsy
Hyperplasia
Estrogens
Endometrium
Epidemiologic Studies
Histology
Carcinogenesis
Therapeutics

All Science Journal Classification (ASJC) codes

  • Cancer Research
  • Oncology

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Prospective multicenter randomized intermediate biomarker study of oral contraceptive versus Depo-Provera for prevention of endometrial cancer in women with Lynch syndrome. / Lu, Karen H.; Loose, David S.; Yates, Melinda S.; Nogueras-Gonzalez, Graciela M.; Munsell, Mark F.; Chen, Lee May; Lynch, Henry T.; Cornelison, Terri; Boyd-Rogers, Stephanie; Rubin, Mary; Daniels, Molly S.; Conrad, Peggy; Milbourne, Andrea; Gershenson, David M.; Broaddus, Russell R.

In: Cancer Prevention Research, Vol. 6, No. 8, 08.2013, p. 774-781.

Research output: Contribution to journalArticle

Lu, KH, Loose, DS, Yates, MS, Nogueras-Gonzalez, GM, Munsell, MF, Chen, LM, Lynch, HT, Cornelison, T, Boyd-Rogers, S, Rubin, M, Daniels, MS, Conrad, P, Milbourne, A, Gershenson, DM & Broaddus, RR 2013, 'Prospective multicenter randomized intermediate biomarker study of oral contraceptive versus Depo-Provera for prevention of endometrial cancer in women with Lynch syndrome', Cancer Prevention Research, vol. 6, no. 8, pp. 774-781. https://doi.org/10.1158/1940-6207.CAPR-13-0020
Lu, Karen H. ; Loose, David S. ; Yates, Melinda S. ; Nogueras-Gonzalez, Graciela M. ; Munsell, Mark F. ; Chen, Lee May ; Lynch, Henry T. ; Cornelison, Terri ; Boyd-Rogers, Stephanie ; Rubin, Mary ; Daniels, Molly S. ; Conrad, Peggy ; Milbourne, Andrea ; Gershenson, David M. ; Broaddus, Russell R. / Prospective multicenter randomized intermediate biomarker study of oral contraceptive versus Depo-Provera for prevention of endometrial cancer in women with Lynch syndrome. In: Cancer Prevention Research. 2013 ; Vol. 6, No. 8. pp. 774-781.
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