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In the past decade, much has been discovered about the molecular profile, or signature, of endometrial cancers. In fact, the entirety of my career has been what seems like a constant open door to new treatments for endometrial cancer.

Traditional classification and treatment for endometrial cancer was based on estrogen receptor status. It was generally thought that estrogen receptor positive tumors had better outcomes versus those that did not have estrogen expression. And initially, hormonal therapy was the mainstay of treatment for these cancers, with good response rates and safety profiles. However with better designed trials and new therapies, most of these hormonal medications are now reserved for very specific patients.

In the current era, most of our endometrial cancer treatment decisions are based on the stage and molecular profile of the tumor. With the long history of good response and excellent safety profiles, the use of hormonal therapy should still be a good option for patients, especially those with medical comorbidities and limitations to standard chemotherapy.

The article by evaluated several current limitations to using hormonal therapy in endometrial cancer -- namely the lack of quality data and non-standardization of immunohistochemistry results and pathways to utilize those. The authors highlight the use of integrating hormonal status for cancers with targeted therapies. In my practice, I have typically used hormonal therapy for early stage fertility sparing, non-surgical candidates, and those with significant comorbidities or a strong desire to avoid cytotoxic chemotherapy.

Breast cancer therapy has used hormonal status as a primary method of treatment pathways for decades with outstanding outcomes, so with further research and definition of hormone receptor and combination with targeted therapies, I think we can look forward to the day when we do the same with endometrial cancer.

Christy Walters Haygood, MD, is a gynecologic oncology specialist at St. Dominic's Jackson Memorial Hospital in Jackson, Mississippi.

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