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Tait DL, Blessing JA, Hoffman JS, Moore KN, Spirtos NM, Lachance JA, Rotmensch J, Miller DS. A phase II study of gemcitabine (gemzar, LY188011) in the treatment of recurrent or persistent endometrial carcinoma: a gynecologic oncology group study. Gynecol Oncol 2010; 121:118-21. [PMID: 21159366 DOI: 10.1016/j.ygyno.2010.11.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/12/2010] [Accepted: 11/17/2010] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The study aims to evaluate the anti-tumor activity and toxicity of gemcitabine in patients with persistent or recurrent endometrial carcinoma. METHODS Patients with advanced or recurrent carcinoma of the endometrium previously treated with one chemotherapy regimen were treated on a phase II trial conducted by the Gynecologic Oncology Group (GOG). Gemcitabine was administered as an intravenous infusion at a dose of 800 mg/m² over 30 min on days 1 and 8 every 21 days. RESULTS Twenty-four patients were entered by 11 GOG member institutions. One patient was ineligible due to wrong primary tumor. A total of ninety 21-day cycles of therapy were administered with 35% of patients receiving four or more cycles. All patients had been previously treated with a platinum-based regimen. One patient had a partial response (4%), nine had stable disease (39%), and twelve had increasing disease (52%). The median progression-free survival was 1.7 months. Treatment was generally well tolerated with only 22% of patients experiencing grade 3 or grade 4 hematologic toxicity. There was one treated-related death due to pulmonary toxicity. CONCLUSION Gemcitabine has minimal activity in the treatment of recurrent or persistent endometrial carcinoma at the dose and schedule tested.
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Affiliation(s)
- David L Tait
- Carolinas Medical Center, Blumenthal Cancer Center, Charlotte, NC 28203, USA.
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202
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Update on gemcitabine and docetaxel combination therapy for primary and metastatic sarcomas. Curr Opin Oncol 2010; 22:356-61. [PMID: 20520541 DOI: 10.1097/cco.0b013e32833aafef] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The combination of fixed-dose-rate gemcitabine and docetaxel has become an established treatment option for advanced uterine leiomyosarcoma and has demonstrated efficacy in nonleiomyosarcoma histology soft-tissue sarcomas. The activity of this regimen in advanced uterine leiomyosarcoma, other soft-tissue sarcomas, and pediatric sarcomas is discussed. RECENT FINDINGS Fixed-dose-rate gemcitabine and docetaxel achieved high objective response rates in three prospective phase II studies as first-line or second-line therapy for advanced uterine leiomyosarcoma. In a randomized trial, the combination of gemcitabine and docetaxel was superior to gemcitabine alone in terms of objective response, progression-free, and overall survival among patients with soft-tissue sarcoma, most of whom had received at least one prior cytotoxic regimen. In a prospective phase II trial, four of 10 pediatric patients with sarcomas achieved complete responses with this regimen. In a small, prospective phase II trial for women with completely resected stage I, II, III, or IV high-grade uterine leiomyosarcoma, adjuvant treatment with gemcitabine-docetaxel was associated with a 2-year progression-free survival rate that appears superior to that of historical controls. SUMMARY Fixed-dose-rate gemcitabine and docetaxel is a reasonable treatment option for patients with advanced soft-tissue sarcoma. The regimen is a good choice as first-line or second-line therapy for advanced uterine leiomyosarcoma. The role of adjuvant gemcitabine-docetaxel in completely resected, uterine-limited, high-grade leiomyosarcoma is under investigation.
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203
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Saraiya B, Chugh R, Karantza V, Mehnert J, Moss RA, Savkina N, Stein MN, Baker LH, Chenevert T, Poplin EA. Phase I study of gemcitabine, docetaxel and imatinib in refractory and relapsed solid tumors. Invest New Drugs 2010; 30:258-65. [PMID: 20697775 DOI: 10.1007/s10637-010-9504-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 07/22/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE In a phase I study, the combination of gemcitabine and imatinib was well tolerated with broad anticancer activity. This phase I trial evaluated the triplet of docetaxel, gemcitabine and imatinib. EXPERIMENTAL DESIGN Imatinib was administered at 400 mg daily on days 1-5, 8-12 and 15-19. Gemcitabine was started at 600 mg/m(2) at a rate of 10 mg/min on days 3 and 10 and docetaxel at 30 mg/m(2) on day 10, on a 21-day cycle. Diffusion and dynamic contrast-enhanced perfusion MRI was performed in selected patients. RESULTS Twenty patients with relapsed/refractory solid tumors were enrolled in this IRB-approved study. The mean age was 64, and mean ECOG PS was 1. Two patients were evaluated by diffusion/perfusion MRI. After two grade 3 hematological toxicities at dose level 1, the protocol was amended to reduce the dose of imatinib. MTDs were 600 mg/ m(2) on days 3 and 10 for gemcitabine, 30 mg/ m(2) on day 10 for docetaxel, and 400 mg daily on days 1-5 and 8-12 for imatinib. Dose limiting toxicities after one cycle were neutropenic fever, and pleural and pericardial effusions. The best response achieved was stable disease, for six cycles, in one patient each with mesothelioma and non small cell lung cancer (NSCLC) at the MTD. Two patients with NSCLC had stable disease for four cycles. DISCUSSION An unexpectedly low MTD for this triplet was identified. Our results suggest drug-drug interactions that amplify toxicities with little evidence of improved tumor control.
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Affiliation(s)
- Biren Saraiya
- The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ 08901, USA.
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Miller BE, Blessing JA, Stehman FB, Shahin MS, Yamada SD, Secord AA, Warshal DP, Abulafia O, Richards WE, Van Le L. A phase II evaluation of weekly gemcitabine and docetaxel for second-line treatment of recurrent carcinosarcoma of the uterus: A gynecologic oncology group study. Gynecol Oncol 2010; 118:139-44. [DOI: 10.1016/j.ygyno.2010.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 03/30/2010] [Accepted: 03/31/2010] [Indexed: 10/19/2022]
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Kobayashi Y, Tozawa A, Okuma Y, Kiguchi K, Ishizuka B. Complete remission with intraperitoneal cisplatin followed by prolonged oral etoposide in a stage IIIc primary leiomyosarcoma of the fallopian tube patient. J Obstet Gynaecol Res 2010; 36:894-7. [DOI: 10.1111/j.1447-0756.2010.01241.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baratti D, Pennacchioli E, Kusamura S, Fiore M, Balestra MR, Colombo C, Mingrone E, Alessanrdro G, Deraco M. Peritoneal Sarcomatosis: Is There a Subset of Patients Who May Benefit from Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy? Ann Surg Oncol 2010; 17:3220-8. [DOI: 10.1245/s10434-010-1178-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Indexed: 12/12/2022]
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Rahaman J, Steiner N, Hayes MP, Chuang L, Fishman D, Gretz Iii H. Chemotherapy for gynecologic cancers. ACTA ACUST UNITED AC 2010; 76:577-88. [PMID: 20014427 DOI: 10.1002/msj.20143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review highlights significant recent developments and trends in chemotherapy for major gynecologic malignancies, i.e., ovarian cancer, endometrial cancer, uterine sarcomas, gestational trophoblastic neoplasia, and cervical cancer. In ovarian cancer, chemotherapeutic options for early, advanced and recurrent disease are in the adjuvant setting as well as in the neoadjuvant setting are explored. For uterine cancer, adjuvant chemotherapy is employed for high risk epithelial subtypes with early disease, such as uterine papillary serous carcinomas, uterine carcinosarcomas and leiomyosarcomas, advanced stage cases, as well as recurrent disease. The review then proceeds to further discuss the appropriate treatment based on the International Federation of Gynecology and Obstetrics prognostic scoring system for gestational trophoblastic neoplasia. Finally, chemotherapy is utilized in cervical cancer as neo-adjuvant therapy prior to surgery or radiation, as a sensitizer concomitantly with radiation therapy or for the treatment of advanced and recurrent disease.
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208
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Krikelis D, Judson I. Role of chemotherapy in the management of soft tissue sarcomas. Expert Rev Anticancer Ther 2010; 10:249-60. [PMID: 20132000 DOI: 10.1586/era.09.176] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Soft tissue sarcomas are a diverse group of rare tumors that comprise 1% of all cancers. Few randomized trials of chemotherapy have been performed but there is a clear role for agents such as doxorubicin and ifosfamide in the palliation of advanced disease. There is uncertainty as to whether sequential single-agent treatment is equivalent to combination chemotherapy. For the majority of histological subtypes adjuvant chemotherapy is not of proven value, although there may be situations where it is advantageous. However, there are other subtypes, such as the Ewing's sarcoma family tumors, for which chemotherapy is an essential part of primary management and has definitely improved survival. Apart from Ewing's sarcoma family tumor and rhabdomyosarcoma, there is increasing specialization of chemotherapy according to histological subtype, such as the use of taxanes for angiosarcoma, gemcitabine and docetaxel for leiomyosarcoma, and trabectedin for leiomyosarcoma and liposarcoma, especially the myxoid/round cell variant. Nevertheless, there are serious limitations to existing treatment and novel therapies need to be developed.
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Affiliation(s)
- Dimitrios Krikelis
- University Hospital of Ioannina, Stavros Niarchos Avenue, 45500, Ioannina, Greece.
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209
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O'Cearbhaill R, Hensley ML. Optimal management of uterine leiomyosarcoma. Expert Rev Anticancer Ther 2010; 10:153-69. [PMID: 20131992 DOI: 10.1586/era.09.187] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Uterine leiomyosarcomas (LMSs) are rare tumors, comprising 1.3% of all uterine cancers. Primary therapy for localized disease entails complete surgical resection. The majority of patients recur within 2 years of primary therapy as these tumors tend to undergo early hematogenous spread. A randomized, controlled trial showed no improvement in the overall or disease-free survival with adjuvant radiotherapy, compared with observation, following resection of early-stage uterine LMS. A Phase II study of adjuvant chemotherapy following complete surgical resection of uterine LMS reported promising results. However, in the absence of Phase III randomized data demonstrating improved outcomes, the role of post-resection chemotherapy for early-stage disease remains experimental. For metastatic or unresectable LMS, systemic chemotherapy forms the mainstay of treatment. First-line treatment options include gemcitabine-docetaxel or doxorubicin with or without ifosfamide. Novel targeted therapies are under investigation in an attempt to devise more effective treatment strategies.
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Affiliation(s)
- Roisin O'Cearbhaill
- Department of Medicine, Gynecologic Medical Oncology Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY 10065, USA
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210
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The Role of Adjuvant Radiation in Uterine Sarcomas. Int J Radiat Oncol Biol Phys 2010; 76:728-34. [DOI: 10.1016/j.ijrobp.2009.02.077] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 01/30/2009] [Accepted: 02/25/2009] [Indexed: 11/22/2022]
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Ueda T, Emoto M, Fukuoka M, Miyahara D, Horiuchi S, Tsujioka H, Kawarabayashi T. Primary leiomyosarcoma of the fallopian tube. Int J Clin Oncol 2010; 15:206-9. [DOI: 10.1007/s10147-010-0027-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Accepted: 08/25/2009] [Indexed: 10/19/2022]
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Bernstein-Molho R, Grisaro D, Soyfer V, Safra T, Merimsky O. Metastatic Uterine Leiomyosarcomas. Int J Gynecol Cancer 2010; 20:255-60. [DOI: 10.1111/igc.0b013e3181c9e289] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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214
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Current World Literature. Curr Opin Obstet Gynecol 2010; 22:87-93. [DOI: 10.1097/gco.0b013e328335462f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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215
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Dhingra S, Rodriguez ME, Shen Q, Duan X, Stanton ML, Chen L, Zhang R, Brown RE. Constitutive activation with overexpression of the mTORC2-phospholipase D1 pathway in uterine leiomyosarcoma and STUMP: morphoproteomic analysis with therapeutic implications. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2010; 4:134-146. [PMID: 21326806 PMCID: PMC3037199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 01/26/2010] [Indexed: 05/30/2023]
Abstract
The mammalian target of rapamycin (mTOR) is centrally involved in growth, survival and metabolism. In cancer, mTOR is frequently hyperactivated and is a clinically validated target for therapy and drug development. Biologically, mTOR acts as the catalytic subunit of two functionally distinct complexes, called mTOR complex 1 (mTORC1) which is predominantly cytoplasmic in subcellular localization and mTOR complex 2 (mTORC2) which is both cytoplasmic and nuclear. mTORC1 is sensitive to the selective inhibitor rapamycin. By contrast, mTORC2 is relatively resistant to rapamycin. Moreover, its putative downstream effector, Akt phosphorylated on serine 473 represents a signal transduction pathway for tumor survival. Phospholipase D (PLD) and its product, phosphatidic acid (PA) have been implicated as an activator of mTOR signaling, including the direct phosphorylative activation of p70S6K atthreonine 389. The latter promotes cell cycle progression. In this study, we investigated the activation status and subcellular localization of mTOR and the relative expression of PLD1, as well as their downstream effectors in a spectrum of uterine smooth muscle tumors using normal myometria as controls. The results show significant activation with overexpression of phosphorylated mTORC2 complex in uterine leiomyosarcoma (ULMS) and smooth muscle tumors of uncertain malignant potential (STUMP) as evidenced by nuclear localization of p-mTOR (Ser 2448) in ULMS>STUMP>uterine leiomyoma and normal myometria (p<0.05) and with overexpression of PLD1(p<0.05). Cor-relatively, there are overexpressions of nuclear p-Akt (Ser 473) and nuclear p-p70S6K (Thr 389) in ULMS and STUMP (p<0.05). The activation with overexpression of components of the mTORC2-PLD1 pathway in ULMS and to a lesser degree in STUMP provides insight into their tumorigenic mechanisms. Thus the development of therapies designed to target mTORC2 and PLD1 activity may be beneficial in treating ULMS.
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Affiliation(s)
- Sadhna Dhingra
- Department of Pathology and Laboratory Medicine, UT Health- Medical School at Houston, 6431 Fannin St, Houston, TX 77030, USA
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216
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Amant F, Coosemans A, Debiec-Rychter M, Timmerman D, Vergote I. Clinical management of uterine sarcomas. Lancet Oncol 2010; 10:1188-98. [PMID: 19959075 DOI: 10.1016/s1470-2045(09)70226-8] [Citation(s) in RCA: 282] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Malignant pure mesenchymal uterine tumours encompass endometrial stromal sarcoma (ESS), uterine leiomyosarcoma, and undifferentiated sarcomas. This Review discusses pathology, preoperative diagnosis, and standard treatment of uterine leiomyosarcoma and low-grade ESS (distinct from undifferentiated uterine sarcomas), with an emphasis on targeted treatment. We show that several features on ultrasonography and MRI can raise suspicion of a uterine sarcoma; however, there are no pathognomonic features on any imaging technique. For both ESS and uterine leiomyosarcoma, hysterectomy with bilateral salpingo-oophorectomy, but without lymphadenectomy, is the standard surgical treatment for early stage disease. The clinical benefit of chemotherapy is limited, which underscores the importance of targeted therapy. ESS and uterine leiomyosarcoma are driven by different pathways, resulting in a different clinical behaviour. ESS typically is a hormone-sensitive tumour with indolent growth. Uterine leiomyosarcoma is notorious for its aggressive growth and poor outcome. Individualisation of treatment is mandatory, because randomised trials are almost non-existent. The progesterone and oestrogen receptors are clinically important targets for most primarily advanced or recurrent ESS and a subset of recurrent uterine leiomyosarcomas. Potential future targets and targeted treatments that are under investigation are presented for both entities.
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Affiliation(s)
- Frédéric Amant
- Leuven Cancer Institute, Gynaecological Oncology, University Hospital Gasthuisberg, Katholieke Universiteit, Leuven, Belgium.
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Ferriss JS, Atkins KA, Lachance JA, Modesitt SC, Jazaeri AA. Temozolomide in Advanced and Recurrent Uterine Leiomyosarcoma and Correlation With O6-Methylguanine DNA Methyltransferase Expression. Int J Gynecol Cancer 2010; 20:120-5. [DOI: 10.1111/igc.0b013e3181c7fe53] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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218
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Outcomes of first-line chemotherapy in patients with advanced or metastatic leiomyosarcoma of uterine and non-uterine origin. Sarcoma 2009; 2009:348910. [PMID: 20066161 PMCID: PMC2801456 DOI: 10.1155/2009/348910] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 10/15/2009] [Indexed: 02/08/2023] Open
Abstract
Although leiomyosarcomas (LMSs) form the largest subgroup of soft tissue sarcomas (STSs), the efficacy of chemotherapy in this group is largely unclear, partly because older studies are contaminated with gastrointestinal stromal tumors (GISTs). In this retrospective study we investigated the outcome of first line chemotherapy in 65 patients with unresectable or metastatic LMS. The overall response rate (ORR) was 18%; and the median progression-free (PFS) and overall survival (OS) were 3.8 and 9.7 months respectively. No statistically significant differences in outcomes for uterine and non-uterine LMS were found. In non-uterine LMS, however, the PFS and OS seemed to be longer for females than for males, potentially negatively affecting outcomes in this group. If our observations are confirmed in other series, they would suggest that studies performed in STS patients should not only stratify for histological subtype but also for uterine versus non-uterine LMS and for gender.
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219
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Abstract
Mesenchymal tumors of the female genital tract include various benign and malignant neoplasms. Mesenchymal tumors may arise from the stroma or associated elements of the organ of origin, such as connective tissue, vascular or neural structures, or others. Malignant mesenchymal tumors of the female genital tract represent a rare group of gynecologic cancers. They are generally aggressive tumors, with a propensity for local and distant recurrence. The mainstay of treatment usually involves surgical excision of the primary tumor. Malignant mesenchymal tumors of the female genital tract are generally refractory to systemic chemotherapy and radiation therapy. This review highlights the treatment options for the most common types of mesenchymal tumors of the female genital tract.
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Affiliation(s)
- Marcela G Del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 9E, Boston, MA 02114, USA.
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220
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O'Cearbhaill R, Zhou Q, Iasonos A, Soslow RA, Leitao MM, Aghajanian C, Hensley ML. Treatment of advanced uterine leiomyosarcoma with aromatase inhibitors. Gynecol Oncol 2009; 116:424-9. [PMID: 19932916 DOI: 10.1016/j.ygyno.2009.10.064] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 10/08/2009] [Accepted: 10/19/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aromatase inhibitors are sometimes used in the treatment of selected patients with uterine leiomyosarcoma (LMS), but there are few data assessing the efficacy of aromatase inhibitors in this setting. METHODS We performed a retrospective electronic medical record review of patients with uterine LMS treated with an aromatase inhibitor at Memorial Sloan-Kettering Cancer Center between 1998 and 2008. We assessed progression-free survival (PFS) and objective response among patients with measurable disease and explored the correlation of hormone receptor status with outcome. RESULTS Forty patients with advanced or recurrent uterine LMS were treated with aromatase inhibitors. Thirty-four patients had measurable disease. Hormone receptor status for these patients was as follows: estrogen receptor (ER) positive-22, ER negative-9, ER unknown-3, progesterone receptor (PR) positive-10, PR negative-10, PR unknown-14. Aromatase inhibitors used were letrozole (in 74% of patients), anastrozole (21%), and exemestane (6%). Median PFS was 2.9 months (95% CI: 1.8-5.1). The 1-year PFS rate was 28% (95% CI: 11-48%) for ER and/or PR positive uterine LMS. Best objective response was partial response (PR) in 3/34 patients (9%) (all of whom were ER positive). CONCLUSIONS In this population of patients with mostly low-volume and ER positive uterine LMS, aromatase inhibitors achieved objective response in only 9%. Relatively prolonged PFS was observed among ER positive uterine LMS patients. In the absence of a no-treatment control group, the prolonged PFS cannot be attributed solely to the activity of the aromatase inhibitor treatment since it may reflect the underlying biology of low-volume, ER positive uterine LMS.
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Affiliation(s)
- Roisin O'Cearbhaill
- Department of Medicine, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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221
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D'Angelo E, Prat J. Uterine sarcomas: a review. Gynecol Oncol 2009; 116:131-9. [PMID: 19853898 DOI: 10.1016/j.ygyno.2009.09.023] [Citation(s) in RCA: 493] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 09/14/2009] [Accepted: 09/15/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Uterine sarcomas are rare tumors that account for 3% of uterine cancers. Their histopathologic classification was revised by the World Health Organization (WHO) in 2003. A new staging system has been recently designed by the International Federation of Gynecology and Obstetrics (FIGO). Currently, there is no consensus on risk factors for adverse outcome. This review summarizes the available clinicopathological data on uterine sarcomas classified by the WHO diagnostic criteria. METHODS Medline was searched between 1976 and 2009 for all publications in English where the studied population included women diagnosed of uterine sarcomas. RESULTS Since carcinosarcomas (malignant mixed mesodermal tumors or MMMT) are currently classified as metaplastic carcinomas, leiomyosarcomas remain the most common uterine sarcomas. Exclusion of several histologic variants of leiomyoma, as well as "smooth muscle tumors of uncertain malignant potential," frequently misdiagnosed as sarcomas, has made apparent that leiomyosarcomas are associated with poor prognosis even when seemingly confined to the uterus. Endometrial stromal sarcomas are indolent tumors associated with long-term survival. Undifferentiated endometrial sarcomas exhibiting nuclear pleomorphism behave more aggressively than tumors showing nuclear uniformity. Adenosarcomas have a favorable prognosis except for tumors showing myometrial invasion or sarcomatous overgrowth. Adenofibromas may represent well-differentiated adenosarcomas. The prognosis of carcinosarcomas (which are considered here in a post-script fashion) is usually worse than that of grade 3 endometrial carcinomas. Immunohistochemical expression of Ki67, p53, and p16 is significantly higher in leiomyosarcomas and undifferentiated endometrial sarcomas than in endometrial stromal sarcomas. CONCLUSIONS Evaluation of H&E stained sections has been equivocal in the prediction of behavior of uterine sarcomas. Immunohistochemical studies of oncoproteins as well as molecular analysis of non-random translocations will undoubtedly lead to an accurate and prognostically relevant classification of these rare tumors.
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Affiliation(s)
- Emanuela D'Angelo
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Sant Antoni M. Claret, 167, 08025 Barcelona, Spain
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Hensley ML, Sill MW, Scribner DR, Brown J, Debernardo RL, Hartenbach EM, McCourt CK, Bosscher JR, Gehrig PA. Sunitinib malate in the treatment of recurrent or persistent uterine leiomyosarcoma: a Gynecologic Oncology Group phase II study. Gynecol Oncol 2009; 115:460-5. [PMID: 19811811 DOI: 10.1016/j.ygyno.2009.09.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 09/02/2009] [Accepted: 09/07/2009] [Indexed: 12/27/2022]
Abstract
PURPOSE New agents are needed for patients with metastatic uterine leiomyosarcoma who progress after treatment with doxorubicin or gemcitabine-docetaxel. Agents targeting tumor vasculature have potential for activity in leiomyosarcoma. We aimed to assess the activity of sunitinib in patients with recurrent uterine leiomyosarcoma who had received one or two prior therapies by determining the frequency of patients who survived progression-free for at least 6 months or who achieved objective tumor response. We also aimed to characterize the toxicity of sunitinib and to estimate time-to-progression. PATIENTS AND METHODS Eligible patients with uterine leiomyosarcoma were treated with sunitinib 50 mg by mouth daily for 4 weeks, with 2 weeks rest. Tumor response and progression-free status were assessed every 6 weeks. RESULTS Twenty-three of 25 patients enrolled were evaluable for efficacy (two wrong histologies). The median number of cycles was one. Two of 23 patients achieved a partial response (8.7%, 90% two-sided, binomial confidence interval (CI) 1.6-24.9%). Four patients remained progression-free at 6 months (17.4%, 90% two-sided, binomial confidence interval 6.2-35.5%). Toxicities included: grade 3 neutropenia (17.4%); grade 3 thrombocytopenia (13%); grade 3 anemia (17.4%); grades 3-4 lymphopenia (8.7%); grades 3-4 fatigue (30%); grade 3 vomiting/diarrhea (21.7%); skin rash/hand-foot syndrome, grade 2 (13%), grade 3 (4.3%); hypertension, grade 2 (39%), grade 3 (4.3%); grade 2 decrease in cardiac ejection fraction (4.3%), and grade 3 thrombosis (4.3%) Median progression-free survival (PFS) was 1.5 months. CONCLUSION Sunitinib fails to achieve sufficient objective response or sustained disease stabilization as second- or third-line treatment for uterine leiomyosarcoma.
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Affiliation(s)
- Martee L Hensley
- Memorial Sloan-Kettering Cancer Center, Department of Medical Oncology, 1275 York Avenue, New York, NY 10065, USA.
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Huang GS, Arend RC, Sakaris A, Hebert TM, Goldberg GL. Extragenital adenosarcoma: a case report, review of the literature, and management discussion. Gynecol Oncol 2009; 115:472-5. [PMID: 19712965 DOI: 10.1016/j.ygyno.2009.07.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 07/21/2009] [Accepted: 07/28/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Müllerian adenosarcoma is a rare mixed epithelial-mesenchymal tumor. An extragenital site of origin and sarcomatous overgrowth are associated with aggressive clinical behavior. CASE We present a rare case of extragenital adenosarcoma with sarcomatous overgrowth and coexistent endometriosis. She was treated with initial cytoreductive surgery and chemotherapy. She underwent a second surgery for management of a high-grade bowel obstruction, due to pathologically confirmed recurrent intraperitoneal adenosarcoma. A complete clinical response was achieved with liposomal doxorubicin, and the patient remains disease-free eighteen months after completion of chemotherapy. CONCLUSION Liposomal doxorubicin appears to be an active agent for the treatment of adenosarcoma with sarcomatous overgrowth. In addition, we conclude from our review of all reported cases of extragenital adenosarcoma that concurrent endometriosis may represent a favorable prognostic factor.
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Affiliation(s)
- Gloria S Huang
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Department of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Albert Einstein Cancer Center, 1695 Eastchester Road, Suite 601, Bronx, NY 10461, USA.
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Maki RG, D'Adamo DR, Keohan ML, Saulle M, Schuetze SM, Undevia SD, Livingston MB, Cooney MM, Hensley ML, Mita MM, Takimoto CH, Kraft AS, Elias AD, Brockstein B, Blachère NE, Edgar MA, Schwartz LH, Qin LX, Antonescu CR, Schwartz GK. Phase II study of sorafenib in patients with metastatic or recurrent sarcomas. J Clin Oncol 2009; 27:3133-40. [PMID: 19451436 PMCID: PMC2716936 DOI: 10.1200/jco.2008.20.4495] [Citation(s) in RCA: 409] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 01/27/2009] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Since activity of sorafenib was observed in sarcoma patients in a phase I study, we performed a multicenter phase II study of daily oral sorafenib in patients with recurrent or metastatic sarcoma. PATIENTS AND METHODS We employed a multiarm study design, each representing a sarcoma subtype with its own Simon optimal two-stage design. In each arm, 12 patients who received 0 to 1 prior lines of therapy were treated (0 to 3 for angiosarcoma and malignant peripheral-nerve sheath tumor). If at least one Response Evaluation Criteria in Solid Tumors (RECIST) was observed, 25 further patients with that sarcoma subtype were accrued. Results Between October 2005 and November 2007, 145 patients were treated; 144 were eligible for toxicity and 122 for response. Median age was 55 years; female-male ratio was 1.8:1. The median number of cycles was 3. Five of 37 patients with angiosarcoma had a partial response (response rate, 14%). This was the only arm to meet the RECIST response rate primary end point. Median progression-free survival was 3.2 months; median overall survival was 14.3 months. Adverse events (typically dermatological) necessitated dose reduction for 61% of patients. Statistical modeling in this limited patient cohort indicated sorafenib toxicity was correlated inversely to patient height. There was no correlation between phosphorylated extracellular signal regulated kinase expression and response in six patients with angiosarcoma with paired pre- and post-therapy biopsies. CONCLUSION As a single agent, sorafenib has activity against angiosarcoma and minimal activity against other sarcomas. Further evaluation of sorafenib in these and possibly other sarcoma subtypes appears warranted, presumably in combination with cytotoxic or kinase-specific agents.
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Affiliation(s)
- Robert G Maki
- Melanoma-Sarcoma Program, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard 909, New York, NY 10065, USA.
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225
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Köhler G. [Uterine sarcoma treatment]. DER PATHOLOGE 2009; 30:304-12. [PMID: 19517111 DOI: 10.1007/s00292-009-1150-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are many common features between uterine sarcomas - leiomyosarcoma, endometrial stromal sarcoma, undifferentiated endometrial sarcoma and adenosarcoma -with regards to course, therapy and follow-up, such as post-menopausal bleeding or additional premenopausal bleeding, as well as rapid growth. There is a new staging system according to FIGO and new therapy recommendations according to NCCN. Prior to therapy, imaging staging of the pelvis, abdomen and chest should be carried out due to the frequency with which metastases are found at the time of diagnosis. In the case of disease spread in uterine sarcomas and malignant mixed tumors, good supportive therapy is a possible therapy option instead of chemo- or radiotherapy. The approach - observation, surgery, lymphonodectomy, mono- or polychemotherapy, radiotherapy, hormone therapy - is chosen according to the extent of spread and the resection status. Neoadjuvant therapies are not as yet established.
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Affiliation(s)
- G Köhler
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum der Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Deutschland.
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Casali P, Jost L, Sleijfer S, Verweij J, Blay JY. Soft tissue sarcomas: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009; 20 Suppl 4:132-6. [DOI: 10.1093/annonc/mdp153] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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227
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Kim K, Choi SC, Ryu SY, Kim JW, Kang SB. Major clinical research advances in gynecologic cancer 2008. J Gynecol Oncol 2008; 19:209-17. [PMID: 19471658 PMCID: PMC2676488 DOI: 10.3802/jgo.2008.19.4.209] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 12/08/2008] [Accepted: 12/09/2008] [Indexed: 11/30/2022] Open
Abstract
In this review, we summarized 14 major clinical advances in gynecology which occurred in 2008. For cervical cancer, clinical impact of HPV vaccine, prognostic value of imaging during radiotherapy, and oncologic/obstetric outcomes of fertility-sparing surgery were chosen. For uterine cancer, optimal method of adjuvant radiotherapy in intermediate-risk patients, extent of lymph node dissection, outcome of robot-assisted staging surgery, new standard chemotherapy regimen for leiomyosarcoma were selected. For ovarian cancer, recent changes in adjuvant therapy, feasibility of neoadjuvant chemotherapy, prediction of optimal secondary cytoreduction, studies on new biomarkers, advances in screening and treatment of women with BRCA mutations were included. For other cancers, the safety of sentinel lymph node dissection in vulvar cancer and chemotherapy regimens for low-risk gestational trophoblastic tumors were reviewed.
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Affiliation(s)
- Kidong Kim
- Department of Obstetrics and Gynecology, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Seok-Cheol Choi
- Department of Obstetrics and Gynecology, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Sang-Young Ryu
- Department of Obstetrics and Gynecology, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Soon-Beom Kang
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Duhan N, Singh S, Kadian YS, Duhan U, Rajotia N, Sangwan N. Primary leiomyosarcoma of broad ligament: case report and review of literature. Arch Gynecol Obstet 2008; 279:705-8. [PMID: 18777035 DOI: 10.1007/s00404-008-0777-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 08/18/2008] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Primary leiomyosarcoma of the broad ligament (LBL) is a very rare and highly malignant gynecological tumor. MATERIALS AND METHODS A 45 year old hysterectomized woman with this rare tumor is presented. Treatment consisted of resection of the tumor along with omental and peritoneal sampling and adjuvant chemotherapy. No evidence of metastasis was present after 15 months of follow up. CONCLUSION Complete surgery along with adjuvant chemotherapy or radiation and a close follow up for recurrence are advocated to optimize disease free survival.
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Affiliation(s)
- Nirmala Duhan
- Department of Obstetrics and Gynecology, Pt BD Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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Fleming G. Gemcitabine/docetaxel—Welcome to a new standard. Gynecol Oncol 2008; 109:313-5. [DOI: 10.1016/j.ygyno.2008.04.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 04/21/2008] [Indexed: 10/22/2022]
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