Diagnosis and management of uterine serous carcinoma: current strategies and clinical challenges

ABSTRACT Introduction Uterine serous carcinoma (USC) is a subtype of endometrial cancer accounting for a disproportionate number of uterine cancer-related deaths. Recent studies have enhanced the understanding of the pathogenesis of USC, advanced treatment guidelines, and have driven the investigation of targeted therapies. A search of the PubMed database was performed for research articles published between 1/1/2005 and 1/1/2020 in which the studied population included women with USC. Areas covered Complete surgical staging, including comprehensive lymphadenectomy and omentectomy, is recommended in all patients. Genomic studies have helped guide treatment recommendations and have driven the development of agents targeting the HER2/neu, PIK3/AKT, and CCNE1/FBXW7 pathways. Platinum/taxane chemotherapy ± radiotherapy is associated with the best survival compared to other treatments for all stages. For those with HER2-positive advanced/recurrent disease, the addition of trastuzumab to carboplatin/paclitaxel improves survival. Expert opinion The rarity of USC limits the feasibility of randomized studies. Systemic chemotherapy is recommended for all stages of USC, particularly in light of the high rates of multi-site or distant recurrence. Pathological testing of tumor samples for molecular targets is expected to play a larger role in guiding clinical management. Clinical trials are needed to establish the clinical efficacy and safety of novel targeted therapies.