Second opinion leads Florida woman from dismissed symptoms to Stage 4 endometrial cancer diagnosis and trial treatment
After postmenopausal bleeding was initially discounted, a second opinion found metastatic disease; she is now in a clinical trial combining hormonal and targeted therapy and reports stable disease
Alla Feldbeyn sought a second opinion after persistent symptoms and a string of delayed appointments from her initial doctor; within days she was diagnosed with Stage 4 endometrial cancer and began systemic treatment.
Feldbeyn, a 68-year-old Florida grandmother, was first diagnosed nearly five years ago with Stage 1 endometrial cancer and underwent a hysterectomy. At the time she was told she did not need chemotherapy or radiation, but in 2022 she developed an incessant cough and new pain in her side. Imaging revealed multiple lesions on her lungs and physicians determined her cancer had metastasized.
Feldbeyn said her original physician did not believe her endometrial cancer had returned and suggested the lung findings represented a different cancer. She also said appointments were repeatedly rescheduled. Dissatisfied with the response, she sought a second opinion and was referred to Dr. Brian Slomovitz, director of gynecologic oncology at Mount Sinai Medical Center in Miami. "[The appointment] was Thursday," Feldbeyn said. "And on Tuesday, I already started chemo."
Clinical notes and her account place key steps in the course of care: after the hysterectomy for Stage 1 disease she was observed without additional adjuvant therapy; symptoms emerged in 2022; lung lesions prompted the second-opinion referral and a rapid transition to systemic therapy. She underwent lung surgery, three months of chemotherapy and subsequently enrolled in a blinded clinical trial of selinexor, an oral agent approved for certain blood cancers. Neither Feldbeyn nor her care team knew if she received the active drug or placebo, and she stopped that trial in October 2023 after disease progression.
The next month she had a lung tumor surgically removed that was close to the spine. Last year she joined a second clinical trial testing a non-chemotherapeutic regimen that combines the hormonal agent letrozole with infusions of Nab-sirolimus, an investigational formulation that uses albumin-bound nanoparticles to deliver sirolimus. The regimen is intended to target both hormonal drivers and molecular pathways in tumor cells.
"In the past, hormonal therapy by itself has been used for the treatment of this disease," Slomovitz said. "However, the response rates are relatively low, and the duration of response is only a couple of months. The focus is now on combining anti-hormonal therapies with targeted therapies tailored to specific tumor biomarkers, a more personalized treatment approach aimed at the hormonal and cellular drivers of the cancer." He added that the nab- formulation may increase effectiveness and reduce severe side effects compared with traditional delivery methods, though Nab-sirolimus has not yet been widely studied in endometrial cancer.
Feldbeyn said she has experienced side effects from the trial regimen, including nosebleeds, coughing, itching, fatigue and high cholesterol, but that her cancer has not progressed since starting the combination. She continues to work remotely as a senior director of a day program for adults with developmental disabilities and said she and her husband continue to take cruises and travel.
Only a small fraction of cancer patients join clinical trials; Slomovitz noted that roughly 7 percent of adults with cancer enroll in trials in the United States each year. Researchers have expanded access to studies nationally and internationally in recent years to ensure therapies are tested across diverse populations.
Feldbeyn, who said she is "loving being a guinea pig," encouraged other patients to advocate for their care, seek second opinions when warranted and consider trial participation. "It can save not only your life, it can save a bunch of other people's lives," she said.
Endometrial cancer, which originates in the lining of the uterus, has become more common in the United States over the past two decades, driven in part by rising obesity rates and the aging population. Slomovitz said that while endometrial cancers were once thought unlikely to recur after hysterectomy, up to about 30 percent of patients now present with advanced or recurrent disease, making deaths from uterine cancers a growing concern. The American Cancer Society projects approximately 13,860 deaths from uterine cancers in the United States this year, compared with about 12,730 deaths from ovarian cancer.
Clinicians advise that any abnormal uterine bleeding should prompt medical evaluation. "Post-menopausal women should not have any bleeding," Slomovitz said. He recommended that a single spot of postmenopausal blood justify a visit to a healthcare provider and urged attention to pelvic or abdominal pain, new urinary discomfort or abnormal vaginal discharge.
Feldbeyn's case highlights both the importance of persistent follow-up when symptoms arise after cancer treatment and the evolving landscape of therapeutic options for recurrent endometrial cancer. Her care reflects a sequence of surgery, conventional chemotherapy, and participation in sequential clinical trials exploring targeted combinations for biomarker-driven disease.
As she continues in the current trial into its second year, Feldbeyn said maintaining quality of life remains a priority. "The great news about Alla is not only her response to the therapy, but she's definitely maintaining her quality of life," Slomovitz said. "For the clinician taking care of her, this is very satisfying and what we want of our patients."
