Disparities in ovarian and uterine cancer in relation to the development of novel therapeutics.
Authors: Johnson Caitlin Ruth , Jiang Ruolin Lorraine , Francoeur Alex Andrea , Richardson Michael , Mann-Grewal Amandeep Kaur , Kapp Daniel Stuart , Chan John K 
Published: June 2024

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Background: As of 2024, the estimated number of deaths related to uterine cancer has surpassed that of ovarian cancer in the US. We proposed to compare FDA approved novel therapeutics between these cancers and identify subgroups that require more novel therapies. Methods: Estimated uterine and ovarian cancer mortality data among U.S. women from 2015-2024 were collected from the American Cancer Society (ACS). Uterine and ovarian cancer incidence data from 2001-2019 were obtained from United States Cancer Statistics (USCS). Data on oncology FDA approvals since 2006 were collected from the FDA website. Clinical trial data was obtained from clinicaltrials.gov. SEER*Stat 8.3.9.2 and Joinpoint regression program 4.9.0.0 were used to calculate cancer incidences and trends per 100,000. Average annual percentage change (AAPC) was used to describe trends. Age-adjusted incidences were adjusted by the U.S. 2000 standard population. SAS Enterprise Guide v 7.1 and Graph Pad Prism v 10.1.1 were additionally used for statistical analysis. Results: Using ACS data, the estimated number uterine cancer deaths was 13,250 compared to 12,740 estimated ovarian cancer deaths in 2024. From 2015-2024, 119,430 estimated uterine and 137,080 estimated ovarian cancer deaths occurred. Over time, the estimated ovarian cancer deaths decreased by -1.1% per year from 14,180 to 12,740 while the estimated uterine cancer deaths increased by 3.0% per year from 10,170 to 13,250 (p<0.001). Using USCS data, uterine cancer incidence was highest among Black women at 28.51/100,000 in 2019. Specifically, Black women had the highest increases in aggressive histologies such as serous carcinoma (AAPC 8.3%; p<0.001), clear cell carcinoma (AAPC 4.2%; p<0.001), and carcinosarcoma (AAPC 4.1%, p<0.001), with Black women aged 55-59 years seeing the highest increase in these aggressive tumors (AAPC 4.9%; p<0.001). However, ovarian cancer incidence among Black women decreased from 10.1 to 7.9/100,000 by -1.5% per year (p<0.001). 252 trials on uterine and ovarian cancer from 2007-2020 were identified. 162 (64.3%) were on ovarian cancer vs 42 (16.7%) on uterine cancer (OR 9.0; 95% CI: 5.95-13.59; p<0.0001). Of 25,773 patients enrolled in these trials, 17,678 (68.6%) were in ovarian cancer trials vs 3,220 (12.5%) in uterine cancer trials (OR 15.3; 95% CI: 14.62-16.00; p<0.001). Additionally, while 8 novel ovarian cancer therapies were FDA approved from 2006-2023, only 3 were approved for uterine cancer. Conclusions: Uterine cancer has surpassed ovarian cancer in mortality, making it the most lethal gynecologic malignancy. Disparities in clinical trial and drug development for the two malignancies could contribute to these findings. Further research should focus on allocating funding to uterine cancer. Given the disparities in the incidence rates in black women, novel research is warranted to identify molecular targets towards developing improved therapies.