A 62-year-old woman with stage IIIC2 endometrial carcinoma (para-aortic lymph node involvement) is being considered for systemic therapy. She has completed surgery and pelvic radiotherapy. She has a performance status of 0 and normal renal and cardiac function. What is the drug of choice for first-line chemotherapy?

Explanation

## First-Line Chemotherapy for Advanced Endometrial Carcinoma (Stage IIIC2) **Key Point:** **Paclitaxel and carboplatin (TC)** is the standard first-line chemotherapy regimen for advanced-stage (IIIC–IV) endometrial carcinoma, regardless of histologic subtype. ### Evidence Base for TC Regimen **High-Yield:** The GOG-99 trial and subsequent phase III studies (including GOG-209) established paclitaxel–carboplatin as the gold standard for advanced endometrial cancer: - Superior overall survival and progression-free survival vs. doxorubicin–cisplatin - Better tolerability profile - Applicable to both endometrioid and non-endometrioid histologies ### Treatment Algorithm for Advanced Endometrial Cancer ```mermaid flowchart TD A[Advanced endometrial carcinoma<br/>Stage IIIC-IV]:::outcome --> B{Histology?}:::decision B -->|Endometrioid| C[Paclitaxel + Carboplatin]:::action B -->|Serous/Clear cell/<br/>Carcinosarcoma| D[Paclitaxel + Carboplatin]:::action C --> E{Response?}:::decision D --> E E -->|Complete/Partial| F[Continue TC x 6 cycles]:::action E -->|Stable/Progressive| G[Consider bevacizumab<br/>or clinical trial]:::action F --> H[Maintenance bevacizumab<br/>if appropriate]:::action ``` **Clinical Pearl:** Bevacizumab (anti-VEGF monoclonal antibody) can be added to TC or used as maintenance therapy in advanced disease, but it is NOT first-line monotherapy. The combination of TC + bevacizumab improves progression-free survival (GOG-86P trial). **Mnemonic:** **TC = Taxane + Carboplatin** — the universal first-line backbone for advanced endometrial cancer across all histologic subtypes.