J Gynecol Oncol.  2014 Jul;25(3):214-220. 10.3802/jgo.2014.25.3.214.

Conservative therapy with metformin plus megestrol acetate for endometrial atypical hyperplasia

• Shan W
• Wang C
• Zhang Z
• Gu C
• Ning C
• Luo X
• Zhou Q
• Chen X

• KMID: 2130102
• DOI: http://doi.org/10.3802/jgo.2014.25.3.214

Abstract

OBJECTIVE
To compare the efficacy of metformin plus megestrol acetate (MA) with that of MA alone for treating endometrial atypical hyperplasia (EAH).
METHODS
This pilot study included 16 EAH patients who met at least one metabolic syndrome (MS) criterion and received either adjunctive metformin plus MA (MET group) or MA monotherapy (MA group). Each patient in the MA group received 160 mg of MA daily, whereas patients in the MET group received the same dose of MA plus 0.5 g of metformin thrice daily. Treatment response was assessed by histological examination of dilation and curettage specimens obtained after 12 weeks of therapy.
RESULTS
Each group had eight patients, and half of the patients in each group were diagnosed with MS. The complete response (CR) rate was 75% (6/8) in the MET group and 25% (2/8) in the MA group (p=0.105). Complications of MS did not affect the response rates in either group. In the MET group, 75% (3/4) of the patients had CR in the presence or absence of MS. In the MA group, 50% (2/4) of the patients with MS had CR, whereas no patient without MS had CR. No irreversible toxicities were observed.
CONCLUSION
Metformin plus MA may be a potential alternative therapy for treating EAH, and the MS status of patients may have no effect on the efficacy of metformin plus MA therapy.

Keyword

Endometrial hyperplasia; Megestrol acetate; Metformin

MeSH Terms

Adult
Antineoplastic Agents, Hormonal/*therapeutic use
Drug Therapy, Combination
Endometrial Hyperplasia/complications/*drug therapy/metabolism
Female
Humans
Hypoglycemic Agents/*therapeutic use
Megestrol Acetate/*therapeutic use
Metabolic Syndrome X/complications/metabolism
Metformin/*therapeutic use
Pilot Projects
Receptors, Estrogen/metabolism
Receptors, Progesterone/metabolism
Single-Blind Method
Treatment Outcome
Antineoplastic Agents, Hormonal
Hypoglycemic Agents
Megestrol Acetate
Metformin
Receptors, Estrogen
Receptors, Progesterone

Figure

• 

  Fig. 1 Study design. CR, complete response; MA, megestrol acetate; MET, metformin plus MA; NR, no response; PR, partial response.

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  Fig. 2 Response distribution in the megestrol acetate (MA) and metformin plus MA (MET) groups in the study. Response distribution was compared between the two groups (p=0.105). CR, complete response; NR, no response; PR, partial response.

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  Fig. 3 Response distribution in the presence and absence of metabolic syndrome (MS) in the megestrol acetate (MA) and metformin plus MA (MET) groups. (A) It shows the response rates of the patients who did not meet the MS criteria in the two groups. Response distribution in the absence of MS was compared between the two groups (p=0.127). (B) It shows the response rates of the patients who met the MS criteria in the two groups. Response distribution in the presence of MS was compared between the two groups (p=0.495). CR, complete response; NR, no response; PR, partial response.

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