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Steinlechner M, Strobel L, Leitner K, Pan TL, Feroz B, Marth C, Zeimet AG. Pegylated liposomal doxorubicin combined with trabectedin as a treatment option in uterine sarcomas: a single-institution retrospective analysis. Int J Gynecol Cancer 2024:ijgc-2023-005170. [PMID: 38688662 DOI: 10.1136/ijgc-2023-005170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE The use of conventional doxorubicin in combination with trabectedin leads to a considerable prolongation of progression-free survival in the treatment of uterine sarcomas but is associated with dose-limiting toxicities. Significant progression-free survival improvement was recently obtained through treatment prolongation with trabectedin single agent. We hypothesize that the therapeutic index of pegylated liposomal doxorubicin combined with trabectedin could be superior to the combination with conventional doxorubicin due to a more favorable toxicity profile. METHODS In this retrospective cohort study, the clinical outcome was analyzed in patients with advanced or recurrent uterine sarcomas with measurable disease treated with pegylated liposomal doxorubicin 30 mg/m2 plus trabectedin 1.5 mg/m2 given every 3 weeks between January 2011 and April 2023 at the University Hospital in Innsbruck. Response evaluation was done every three cycles. Toxicity was evaluated according to the National Cancer Institute (NCI) Common Terminology Criteria on 107 administered cycles. RESULTS A total of 21 patients were included in the study. In 67% (n=14) of patients, pegylated liposomal doxorubicin plus trabectedin was given as first-line treatment. One patient (5%) achieved a complete response and four (19%) a partial response, resulting in an objective response rate of 24%. Four other patients (19%) had stable disease. The median duration of the response was 14 months (range 3-74). Progression was recorded in 12 patients (57%). Median progression-free survival was 6 months (95% CI 1 to 11 months), while median overall survival was 26 months (95% CI 9 to 43 months). A median of 6 (range 1-11) cycles per patient were administered. Regarding grade ≥3 toxicity, neutropenia was recorded in 29%, thrombocytopenia in 14%, and febrile neutropenia in 19% of patients. Hematologic toxicity was the most frequent reason for dose delays (n=16) and dose reductions (n=5). CONCLUSION Our study found an overall clinical benefit for the combination of pegylated liposomal doxorubicin plus trabectedin in metastatic uterine sarcomas of 43% and appears to exhibit a favorable toxicity profile which allows prolonged administration of this regimen.
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Affiliation(s)
- Magdalena Steinlechner
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Laura Strobel
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Katharina Leitner
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Teresa L Pan
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Barin Feroz
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Marth
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Alain G Zeimet
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
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2
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Ferron G, Bataillon G, Martinez A, Chibon F, Valentin T. Gynecological sarcomas, surgical management: primary, metastatic, and recurrent disease. Int J Gynecol Cancer 2024; 34:393-402. [PMID: 38438176 DOI: 10.1136/ijgc-2023-004582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Adult-type gynecological soft tissue and visceral sarcomas are rare tumors, with an estimated incidence of 13% of all sarcomas and 4% of all gynecological malignancies. They most often develop in the uterus (83%), followed by the ovaries (8%), vulva and vagina (5%), and other gynecological organs (2%). The objective of this review is to provide an overview of the current management of gynecological sarcomas, according to international guidelines. The management of gynecological sarcomas should follow the recommendations for the management of soft tissue and visceral sarcomas. Centralizing cases in expert centers improves patient survival, both for the diagnostic phase and for multidisciplinary therapeutic management. In the case of pelvic soft tissue sarcomas, a radiological biopsy is essential before any surgical decision is taken. In the case of a myometrial tumour which may correspond to a sarcoma, if conservative surgery such as myomectomy or morcellation is planned, an ultrasound-guided biopsy with pathological analysis including comparative genomic hybridization analysis must be carried out. In all cases, en bloc surgery, without rupture, is mandatory. Many rare histological subtypes require specific surgical management.
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Affiliation(s)
- Gwenael Ferron
- Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
- OncoSARC (Oncogenesis of Sarcoma), INSERM UMR1037, Toulouse, France
| | - Guillaume Bataillon
- Anatomopathology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Alejandra Martinez
- Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
- T2i (Anti-tumour immunity and immunotherapy), INSERM UMR1037, Toulouse, France
| | - Frederic Chibon
- OncoSARC (Oncogenesis of Sarcoma), INSERM UMR1037, Toulouse, France
- Surgical Pathology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Thibaud Valentin
- OncoSARC (Oncogenesis of Sarcoma), INSERM UMR1037, Toulouse, France
- Medical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
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3
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Pautier P, Italiano A, Piperno-Neumann S, Chevreau C, Penel N, Firmin N, Boudou-Rouquette P, Bertucci F, Balleyguier C, Lebrun-Ly V, Ray-Coquard I, Kalbacher E, Bardet A, Bompas E, Collard O, Isambert N, Guillemet C, Rios M, Archambaud B, Duffaud F, ITALIANO A, PAUTIER P, LECESNE A, PIPERNO-NEUMANN S, CHEVREAU C, CUPISSOL D, PENEL N, ALEXANDRE J, BERTUCCI F, RAY-COQUARD I, LEBRUN-LY V, KALBACHER E, DUFFAUD F, DELCAMBRE C, BOMPAS E, COLLARD O, ISAMBERT N, GUILLEMET C, SOULIE P, RIOS M, SAADA-BOUZID E. Doxorubicin alone versus doxorubicin with trabectedin followed by trabectedin alone as first-line therapy for metastatic or unresectable leiomyosarcoma (LMS-04): a randomised, multicentre, open-label phase 3 trial. Lancet Oncol 2022; 23:1044-1054. [DOI: 10.1016/s1470-2045(22)00380-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/05/2022] [Accepted: 06/10/2022] [Indexed: 10/17/2022]
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4
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Li M, Lee AX, Wong WL, Tan KT. Benign metastasising leiomyoma: a rare disease and a diagnostic challenge. BMJ Case Rep 2022; 15:e248575. [PMID: 35835485 PMCID: PMC9289031 DOI: 10.1136/bcr-2021-248575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Benign metastasising leiomyoma (BML) is a rare tumour characterised by extrauterine metastasis of histologically benign leiomyomas. We present a case of BML with pulmonary involvement. A 49-year-old woman presented with large pelviabdominal masses complicated by gross abdominal and lower limb swelling 6 years following open myomectomy. Preoperative CT imaging showed pelviabdominal masses and multiple bilateral pulmonary nodules. Initial impression was that of a stage 4 gynaecological malignancy. Palliative total hysterectomy bilateral salpingo-oophorectomy was performed. Histopathology confirmed benign uterine leiomyomas. Biopsy of pulmonary nodules showed benign leiomyomas, strongly positive for oestrogen and progesterone receptors. Definitive diagnosis of BML was made on histopathology and immunohistochemistry. The patient declined letrozole treatment as she had just undergone bilateral oophorectomy. She opted for conservative monitoring of her lung nodules. CT imaging 7 months postsurgery showed disease regression. She will require long-term surveillance scans to detect disease progression.
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Affiliation(s)
- Mingyue Li
- Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Ai Xin Lee
- Ministry of Health Holdings Pte Ltd, Singapore
| | - Wai Loong Wong
- Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Kim Teng Tan
- O&G, KK Women's and Children's Hospital, Singapore
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5
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Koufopoulos N, Damaskou V, Siozopoulou V, Kokoropoulos P, Gouloumis AR, Arkadopoulos N, Panayiotides IG. DOG1-Positive Primary Mesenteric Leiomyosarcoma: Report of a Case and Review of the Literature. Cureus 2022; 14:e25263. [PMID: 35755504 PMCID: PMC9224980 DOI: 10.7759/cureus.25263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/20/2022] Open
Abstract
The mesentery constitutes a common location for the metastatic spread of malignant gastrointestinal tumors. Primary mesenteric tumors, on the other hand, are very rare; lymphomas are the most common, followed by benign and malignant mesenchymal tumors. We present a case of a 43-year-old patient operated on for a primary mesenteric leiomyosarcoma with a positive immunostain for DOG1, despite having no KIT or PDGFRa mutations on molecular analysis. Moreover, we review the pertinent literature.
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6
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Stork T, Hegedüs B, Guder W, Hamacher R, Hardes J, Kaths M, Plönes T, Pöttgen C, Schildhaus HU, Streitbürger A, Treckmann J, Bauer S, Aigner C, Collaud S. Prognostic Factors for Leiomyosarcoma with Isolated Metastases to the Lungs: Impact of Metastasectomy. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11806-8. [PMID: 35552929 PMCID: PMC9174305 DOI: 10.1245/s10434-022-11806-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Leiomyosarcoma (LMS) most frequently metastasizes to the lung. Metastatic LMS is considered incurable. Selected patients may benefit from pulmonary metastasectomy (PM) within multimodal therapy. This study analyzed the prognostic relevance of clinicopathologic factors in these patients. METHODS Patients with metastatic LMS to the lung treated in our center from 2004 to 2020 were included in this single-center retrospective study. Overall survival (OS), progression-free survival (PFS), and prognostic factors were analyzed. RESULTS The study had 64 patients (33 males, 52%) with metastatic LMS to the lung. The 5-year OS was 55% after the diagnosis of pulmonary metastases. Age older than 60 years at the primary tumor diagnosis, primary tumor larger than 70 mm, and five or more lung metastases were associated with poorer OS. Of the 64 patients, 44 underwent PM. The postoperative mortality rate was 0%. The patients selected for PM were younger and had smaller primary tumors, fewer metastases, and metastases that more often were metachronous. Metastasis grade (G1 vs. G2/3) and size (20-mm cutoff) were significant prognostic factors for OS (p = 0.05) and PFS (p = 0.028) after PM, respectively. The 44 patients who underwent PM had a survival benefit compared with the patients who were selected but did not undergo PM (n = 6) and the patients who were not selected for PM (n = 14). Three patients (7%) were alive and free of disease at the last follow-up visit respectively 5.5, 9, and 12 years after PM. CONCLUSIONS For patients with leiomyosarcoma, PM is safe. Despite aggressive multimodal treatment, most patients will experience recurrence and eventually die of their disease. However, a small subgroup of patients could potentially be cured after PM.
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Affiliation(s)
- Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
| | - Balazs Hegedüs
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
| | - Wiebke Guder
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rainer Hamacher
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jendrik Hardes
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Moritz Kaths
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Till Plönes
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
| | - Christoph Pöttgen
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hans-Ulrich Schildhaus
- German Cancer Consortium (DKTK), Center Essen, Germany
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Arne Streitbürger
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Juergen Treckmann
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sebastian Bauer
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany.
- German Cancer Consortium (DKTK), Center Essen, Germany.
| | - Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
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7
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Impact of Surgery and Chemotherapy on Metastatic Extrauterine Leiomyosarcoma. Curr Oncol 2022; 29:2301-2311. [PMID: 35448161 PMCID: PMC9029669 DOI: 10.3390/curroncol29040187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 01/21/2023] Open
Abstract
Background: Few studies have described the characteristics and prognostic factors of patients with metastatic extrauterine leiomyosarcoma (euLMS). Therefore, we retrospectively investigated the clinicopathological features, clinical outcomes, and prognostic factors of patients with euLMS. Methods: We recruited 61 patients with metastatic euLMS treated from 2006 to 2020 and collected and statistically analyzed information on patient-, tumor-, and treatment-related factors. The median follow-up period was 21.1 months. Results: Sixty-one patients with euLMS and a median age of 59 years were included. Furthermore, their five-year overall survival (OS) rate was 38.3%. Univariate analysis revealed that primary tumor size >10 cm, synchronous metastasis, initial metastatic sites >1, and no metastasectomy with curative intent were significantly associated with poor OS rate. Multivariate analysis identified primary tumor size >10 cm as an independent prognostic factor for poor OS. Among 24 patients who received metastasectomy with curative intent, the interval from the initial diagnosis to development of metastasis ≤6 months was significantly correlated with unfavorable OS. Among 37 patients who did not receive metastasectomy, chemotherapy after metastasis development was significantly related to better OS. Conclusions: Complete metastasectomy should be considered for metastatic euLMS treatment. Moreover, chemotherapy could prolong survival in patients with metastasis who are ineligible for metastasectomy.
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8
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Kasper B, D'Ambrosio L, Davis EJ, Ingham M, Broto JM, Trent JC, van Houdt WJ, Van Tine BA. What Clinical Trials Are Needed for Treatment of Leiomyosarcoma? Curr Treat Options Oncol 2022; 23:439-449. [PMID: 35275323 PMCID: PMC8930904 DOI: 10.1007/s11864-021-00928-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/27/2022]
Abstract
OPINION STATEMENT Leiomyosarcoma is one of the most common subtypes of soft tissue sarcomas accounting for approximately 20% of sarcomas. As leiomyosarcoma patients frequently develop metastatic disease, effective systemic therapies are needed to improve clinical outcomes. The overall activity of the currently available conventional systemic therapies and the prognosis of patients with advanced and/or metastatic disease are poor. As such, the treatment of this patient population remains challenging. As a result, there is a clear unmet medical need, and designing and performing meaningful clinical studies are of utmost importance to improve the prognosis of this patient group. Therefore, the aim of this review is to briefly summarize state-of-the-art treatments for leiomyosarcoma patients and to describe trial characteristics needed for informative clinical studies.
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Affiliation(s)
- Bernd Kasper
- Mannheim University Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.
| | | | - Elizabeth J Davis
- Department of Internal Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, USA
| | | | - Javier Martin Broto
- Medical Oncology Department, University Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | - Jonathan C Trent
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, USA
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Brian A Van Tine
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, USA
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9
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Walter SS, Fritz J. MRI of Muscular Neoplasms and Tumor-Like Lesions: A 2020 World Health Organization Classification-based Systematic Review. Semin Roentgenol 2022; 57:252-274. [DOI: 10.1053/j.ro.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/03/2022] [Accepted: 01/08/2022] [Indexed: 11/11/2022]
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10
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Kantidakis G, Litière S, Neven A, Vinches M, Judson I, Schöffski P, Wardelmann E, Stacchiotti S, D'Ambrosio L, Marréaud S, van der Graaf WTA, Kasper B, Fiocco M, Gelderblom H. Efficacy thresholds for clinical trials with advanced or metastatic leiomyosarcoma patients: A European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group meta-analysis based on a literature review for soft-tissue sarcomas. Eur J Cancer 2021; 154:253-268. [PMID: 34298376 DOI: 10.1016/j.ejca.2021.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND In 2002, the European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group reported well-established values for conducting phase II trials for soft-tissue sarcomas. An update is provided for leiomyosarcoma (LMS). MATERIALS AND METHODS Clinical trials with advanced or metastatic LMS were identified via literature review in PubMed (published 2003-2018, ≥10 adult LMS patients). End-points were 3- and 6-month progression-free survival rates (PFSR-3m and PFSR-6m). When estimates could not be derived from publications, data requests were sent out. Treatments were classified as recommended (R-T) or non-recommended (NR-T) according to the ESMO 2018 guidelines. A random effects meta-analysis was used to pool trial-specific estimates for first-line (1L) or pre-treated (2L+) patients separately. The ESMO Magnitude of Clinical Benefit Scale was used to guide the treatment effect to target in future trials. RESULTS From 47 studies identified, we obtained information on 7 1L and 16 2L+ trials for 1500 LMS patients. Overall, in 1L, PFSR-3m and PFSR-6m were 74% (95% confidence interval [CI] 64-82%) and 58% (95% CI 50-66%), respectively. For 2L+, PFSR-3m was 48% (95% CI 41-54%), and PFSR-6m was 28% (95% CI 22-34%). No difference was observed between R-T and NR-T for first or later lines. Under the alternative that the true benefit amounts to a hazard ratio of 0.65, a PFSR-6m ≥70% can be considered to suggest drug activity in 1L. For 2L+, a PFSR-3m ≥62% or PFSR-6m ≥44% would suggest drug activity. Specific results are also provided for uterine LMS. CONCLUSIONS This work provides a new benchmark for designing phase II studies for advanced or metastatic LMS.
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Affiliation(s)
| | | | | | | | - Ian Judson
- Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Eva Wardelmann
- Gerhard Domagk Institute of Pathology, University Hospital Münster, Germany
| | - Silvia Stacchiotti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Lorenzo D'Ambrosio
- Sarcoma Unit, Division of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | | | - Winette T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bernd Kasper
- Sarcoma Unit, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Marta Fiocco
- Mathematical Institute Leiden University, Leiden, the Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
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11
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Kasper B, Achee A, Schuster K, Wilson R, van Oortmerssen G, Gladdy RA, Hemming ML, Huang P, Ingham M, Jones RL, Pollack SM, Reinke D, Sanfilippo R, Schuetze SM, Somaiah N, Van Tine BA, Wilky B, Okuno S, Trent J. Unmet Medical Needs and Future Perspectives for Leiomyosarcoma Patients-A Position Paper from the National LeioMyoSarcoma Foundation (NLMSF) and Sarcoma Patients EuroNet (SPAEN). Cancers (Basel) 2021; 13:886. [PMID: 33672607 PMCID: PMC7924026 DOI: 10.3390/cancers13040886] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 02/07/2023] Open
Abstract
As leiomyosarcoma patients are challenged by the development of metastatic disease, effective systemic therapies are the cornerstone of outcome. However, the overall activity of the currently available conventional systemic treatments and the prognosis of patients with advanced or metastatic disease are still poor, making the treatment of this patient group challenging. Therefore, in a joint effort together with patient networks and organizations, namely Sarcoma Patients EuroNet (SPAEN), the international network of sarcoma patients organizations, and the National LeioMyoSarcoma Foundation (NLMSF) in the United States, we aim to summarize state-of-the-art treatments for leiomyosarcoma patients in order to identify knowledge gaps and current unmet needs, thereby guiding the community to design innovative clinical trials and basic research and close these research gaps. This position paper arose from a leiomyosarcoma research meeting in October 2020 hosted by the NLMSF and SPAEN.
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Affiliation(s)
- Bernd Kasper
- Mannheim University Medical Center, University of Heidelberg, 68167 Mannheim, Germany
| | - Annie Achee
- National LeioMyoSarcoma Foundation (NLMSF), Denver, CO 80222, USA;
| | - Kathrin Schuster
- Sarcoma Patients EuroNet, SPAEN, 61200 Wölfersheim, Germany; (K.S.); (R.W.); (G.v.O.)
| | - Roger Wilson
- Sarcoma Patients EuroNet, SPAEN, 61200 Wölfersheim, Germany; (K.S.); (R.W.); (G.v.O.)
| | | | - Rebecca A. Gladdy
- Department of Surgery, Mount Sinai Hospital, Toronto, ON M5G 1XS, Canada;
| | | | - Paul Huang
- Institute of Cancer Research, London SM2 5NG, UK; (P.H.); (R.L.J.)
| | - Matthew Ingham
- Department of Medicine, Columbia University School of Medicine, New York, NY 10032, USA;
| | - Robin L. Jones
- Institute of Cancer Research, London SM2 5NG, UK; (P.H.); (R.L.J.)
- Royal Marsden Hospital, London SW3 6JJ, UK
| | - Seth M. Pollack
- Northwestern Medicine, Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Denise Reinke
- Sarcoma Alliance for Research through Collaboration (SARC), Ann Arbor, MI 48105, USA;
| | | | - Scott M. Schuetze
- Michigan Medicine Sarcoma Clinic, Rogel Cancer Center, Ann Arbor, MI 48109, USA;
| | - Neeta Somaiah
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Care Center, Houston, TX 77030, USA;
| | - Brian A. Van Tine
- Barnes and Jewish Hospital, Washington University in St. Louis, St. Louis, MO 63110, USA;
| | - Breelyn Wilky
- Department of Sarcoma Medical Oncology, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA;
| | - Scott Okuno
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Jonathan Trent
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA;
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12
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Penel N, Ryckewaert T, Pannier D. Deleterious effect of ifosfamide in leiomyosarcoma: Convergence of weak signals. Cancer 2020; 126:4614-4615. [DOI: 10.1002/cncr.33111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/07/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Nicolas Penel
- Medical Oncology Department Oscar Lambret Center Lille France
- Lille University School of Medicine Lille France
| | | | - Diane Pannier
- Medical Oncology Department Oscar Lambret Center Lille France
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13
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D'Ambrosio L, Litière S, Stacchiotti S, Gronchi A. Reply to Deleterious effect of ifosfamide in leiomyosarcoma: Convergence of weak signals. Cancer 2020; 126:4615-4616. [PMID: 32767667 DOI: 10.1002/cncr.33110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Lorenzo D'Ambrosio
- Department of Oncology, University of Turin, Turin, Italy.,Sarcoma Unit, Division of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Saskia Litière
- Statistics, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Silvia Stacchiotti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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14
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Arshad J, Barreto-Coelho P, Jonczak E, Espejo A, D'Amato G, Trent JC. Identification of Genetic Alterations by Circulating Tumor DNA in Leiomyosarcoma: A Molecular Analysis of 73 Patients. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2020; 3:64-68. [PMID: 36751526 PMCID: PMC9179395 DOI: 10.36401/jipo-20-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/31/2020] [Indexed: 01/20/2023]
Abstract
Background Leiomyosarcoma is a malignant mesenchymal tumor of cells of smooth muscle lineage arising commonly in retroperitoneum, uterus, large veins, and the limbs. The genetics of leiomyosarcomas are complex and there is very limited understanding of common driver mutations. Circulating tumor DNA (ctDNA) offers a rapid and noninvasive method of next-generation sequencing (NGS) that could be used for diagnosis, therapy, and detection of recurrence. Methods ctDNA testing was performed using Guardant360, which detects single nucleotide variants, amplifications, fusions, and specific insertion/deletion mutations in 73 genes using NGS. Results Of 73 patients, 59 were found to have one or more cancer-associated genomic alteration. Forty-five (76%) were female with a median age of 63 (range, 38-87) years. All samples were designated metastatic. The most common alterations were detected in Tp53 (65%), BRAF (13%), CCNE (13%), EGFR (12%), PIK3CA (12%), FGFR1 (10%), RB1(10%), KIT (8%), and PDGFRA (8%). Some of the other alterations included RAF1, ERBB2, MET, PTEN TERT, APC, and NOTCH1. Potentially targetable mutations, by Food and Drug Administration-approved or clinical trials, were found in 24 (40%) of the 73 patients. Four patients (5%) were found to have incidental germline TP53 mutations. Conclusion NGS of ctDNA allows identification of genomic alterations in plasma from patients with leiomyosarcoma. Unfortunately, there is limited activity of current targeted agents in leiomyosarcomas. These results suggest opportunities to develop therapy against TP53, cell cycle, and kinase signaling pathways. Further validation and prospective evaluation is warranted to investigate the clinical utility of ctDNA for patients with leiomyosarcoma.
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Affiliation(s)
- Junaid Arshad
- Department of Medicine, Division of Medical Oncology, Miller School of Medicine, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - Priscila Barreto-Coelho
- Department of Medicine, Division of Internal Medicine, Miller School of Medicine, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - Emily Jonczak
- Department of Medicine, Division of Medical Oncology, Miller School of Medicine, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - Andrea Espejo
- Department of Medicine, Division of Medical Oncology, Miller School of Medicine, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - Gina D'Amato
- Department of Medicine, Division of Medical Oncology, Miller School of Medicine, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
,Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Jonathan C. Trent
- Department of Medicine, Division of Medical Oncology, Miller School of Medicine, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
,Sylvester Comprehensive Cancer Center, Miami, FL, USA
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Younger E, Husson O, Asare B, Benson C, Judson I, Miah A, Zaidi S, Dunlop A, Al-Muderis O, van Houdt WJ, Jones RL, van der Graaf WTA. Metastatic Soft Tissue Sarcomas in Adolescents and Young Adults: A Specialist Center Experience. J Adolesc Young Adult Oncol 2020; 9:628-638. [PMID: 32379517 PMCID: PMC7757586 DOI: 10.1089/jayao.2020.0010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose: Soft tissue sarcomas (STS) account for 8% of all cancers in adolescents and young adults (AYAs). Metastatic STS contribute significantly to disease-related mortality in this age group; however, data are limited due to under-representation in clinical trials. Methods: AYAs aged 18-39 years, diagnosed with metastatic STS between 1990 and 2012, were identified from The Royal Marsden Hospital database. Outcomes of interest were clinical characteristics, treatment patterns, overall survival (OS), and prognostic factors. Results: Overall, 455 patients were included. Median age at diagnosis of metastatic STS was 33 years (interquartile range [IQR] 27-37 years). The most common histological subtypes were leiomyosarcoma (n = 68, 15%), synovial sarcoma (n = 68, 15%), Ewing sarcoma (n = 44, 10%), and rhabdomyosarcoma (n = 35, 8%). Treatments included systemic therapy (n = 395, 87%; median 2 lines [IQR 1-3]; clinical trial n = 93, 22%), radiotherapy (n = 297, 66%), and metastasectomy (n = 191, 43%). Median duration between last chemotherapy regimen and death was 4.6 months (IQR 2-10). Median OS was 19.2 months (95% confidence interval [CI] 15.8-22.2); 5-year OS was 16%. Of common subtypes, patients with rhabdomyosarcoma had the worst OS (8.8 months; 95% CI 7.9-11.4). Adverse prognostic factors included male gender, synchronous metastases, bone or liver metastases, first-line polychemotherapy, and no metastasectomy. Conclusions: Outcomes were variable; patients with supposed chemosensitive subtypes had particularly poor survival. The diverse behavior of STS in AYAs highlights the need for subtype-specific clinical trials.
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Affiliation(s)
- Eugenie Younger
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Olga Husson
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Bernice Asare
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Charlotte Benson
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ian Judson
- Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Aisha Miah
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Shane Zaidi
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alison Dunlop
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Omar Al-Muderis
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Winan J van Houdt
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Robin L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Winette T A van der Graaf
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
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SARC018_SPORE02: Phase II Study of Mocetinostat Administered with Gemcitabine for Patients with Metastatic Leiomyosarcoma with Progression or Relapse following Prior Treatment with Gemcitabine-Containing Therapy. Sarcoma 2018; 2018:2068517. [PMID: 30473623 PMCID: PMC6220374 DOI: 10.1155/2018/2068517] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/07/2018] [Accepted: 10/02/2018] [Indexed: 02/07/2023] Open
Abstract
Histone deacetylase inhibitors (HDACi) can reverse chemoresistance, enhance chemotherapy-induced cytotoxicity, and reduce sarcoma proliferation in cell lines and animal models. We sought to determine the safety and toxicity of mocetinostat and its ability to reverse chemoresistance when administered with gemcitabine in patients with metastatic leiomyosarcoma resistant to prior gemcitabine-containing therapy. Participants with metastatic leiomyosarcoma received mocetinostat orally, 70 mg per day, three days per week, increasing to 90 mg after three weeks if well tolerated. Gemcitabine was administered at 1,000 mg/m2 intravenously at 10 mg/m2/minute on days five and 12 of every 21-day cycle. Disease response was evaluated with CT or MRI. Twenty participants with leiomyosarcoma were evaluated for toxicity. Median time to disease progression was 2.0 months (95% CI 1.54–3.12). Eighteen participants were evaluated for radiologic response by RECIST 1.1. Best responses included one PR and 12 SD. Tumor size reduced in 3 patients. Most common toxicities were fatigue, thrombocytopenia, anemia, nausea, and anorexia. One patient experienced a significant pericardial adverse event. No study-related deaths were observed. Rechallenging with gemcitabine by adding mocetinostat was feasible and demonstrated modest activity in patients with leiomyosarcoma. Further studies are needed to better define the role of HDAC inhibitors in patients with metastatic leiomyosarcoma.
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17
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Akin S, Dizdar O, Karakas Y, Turker A, Kars A. Ifosfamide and doxorubicin in the treatment of advanced leiomyosarcoma. Curr Probl Cancer 2018; 42:344-349. [DOI: 10.1016/j.currproblcancer.2018.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 11/27/2022]
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18
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Kostine M, Briaire-de Bruijn IH, Cleven AHG, Vervat C, Corver WE, Schilham MW, Van Beelen E, van Boven H, Haas RL, Italiano A, Cleton-Jansen AM, Bovée JVMG. Increased infiltration of M2-macrophages, T-cells and PD-L1 expression in high grade leiomyosarcomas supports immunotherapeutic strategies. Oncoimmunology 2017; 7:e1386828. [PMID: 29308311 PMCID: PMC5749622 DOI: 10.1080/2162402x.2017.1386828] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 10/25/2022] Open
Abstract
Background: Immunotherapy may be a rational strategy in leiomyosarcoma (LMS), a tumor known for its genomic complexity. As a prerequisite for therapeutic applications, we characterized the immune microenvironment in LMS, as well as its prognostic value. Methods: CD163+ macrophages, CD3+ T-cells, PD-L1/PD-L2 and HLA class I expression (HCA2, HC10 and β2m) were evaluated using immunohistochemistry in primary tumors (n = 75), local relapses (n = 6) and metastases (n = 19) of 87 LMS patients, as well as in benign leiomyomas (n = 7). Correlation with clinicopathological parameters and survival analyses were assessed. Effect of LMS cells on macrophage differentiation was investigated using coculture of CD14+ monocytes with LMS cell lines or their conditioned media (CM). Results: 58% and 52% of the tumors were highly infiltrated with CD163+ macrophages and T-cells, respectively, with HLA class I expression observed in almost all tumors and PD-L1 expression in 30%. PD-L2 expression was also detected in some PD-L1+ tumors. All these immune markers correlated with high tumor grade but only CD163 associated with overall survival (p = 0.003) and disease-specific survival (p = 0.041). In vitro, CD163 was upregulated in the presence of LMS cells producing M-CSF, suggesting that this tumor drives macrophages towards the M2 phenotype. Conclusion: The clinical significance of M2 macrophages, possibly induced by LMS cell-secreted factors, suggests that 2/3 of high-grade LMS patients might benefit from macrophage-targeting agents. Furthermore, PD-L1 expression together with high T-cell infiltrate and HLA class I expression in around 30% of high grade LMS reflects an active immune microenvironment potentially responsive to immune checkpoint inhibitors.
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Affiliation(s)
- Marie Kostine
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Hôpital Pellegrin, Place Amélie Raba Léon, Bordeaux, France
| | | | - Arjen H G Cleven
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Carly Vervat
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem E Corver
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marco W Schilham
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Els Van Beelen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Hester van Boven
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Rick L Haas
- Department of Radiotherapy, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | | | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
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19
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Aoki H, Arata T, Utsumi M, Mushiake Y, Kunitomo T, Yasuhara I, Taniguchi F, Katsuda K, Tanakaya K, Takeuchi H, Yamasaki R. Synchronous coexistence of liver metastases from cecal leiomyosarcoma and rectal adenocarcinoma: A case report. World J Gastroenterol 2017; 23:1725-1734. [PMID: 28321173 PMCID: PMC5340824 DOI: 10.3748/wjg.v23.i9.1725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/16/2017] [Accepted: 02/08/2017] [Indexed: 02/06/2023] Open
Abstract
Multiple liver tumors represent a challenging condition for abdominal surgeons both in the selection of technique and the rarity of diagnosis. There are no case reports on co-existence of liver metastases from both intestinal leiomyosarcoma and adenocarcinoma. The patient described in this report successfully underwent resection of both primary lesions and liver metastases in combination with chemotherapy. As for the leiomyosarcoma, the primary cecal lesion was revealed more than three years after the patient's first visit. Peritoneal, lymph-node, and lung recurrences were observed afterward, and thus surgeries on those regions were performed. Pathologically, the peritoneal and lung recurrences comprised leiomyosarcoma and the lymph-node recurrence was diagnosed as adenocarcinoma. Despite newly discovered multiple lung recurrences and regional lymph-node metastases, the patient lived a normal life for 73 mo after the initial operation based on multidisciplinary therapy. He ultimately died of liver failure due to invasive lymph-node recurrence from the rectal adenocarcinoma, in addition to multiple lung recurrences from the leiomyosarcoma. Hepatic recurrence did not occur in this patient's case, which appears to be one reason for his long-term survival.
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20
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Ahuja A, Agarwal P, Sardana R, Bhaskar S. Extensively Metastasizing Leiomyosarcoma: A Diagnostic Challenge. J Midlife Health 2017; 8:148-150. [PMID: 28983164 PMCID: PMC5625581 DOI: 10.4103/jmh.jmh_60_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Uterine leiomyosarcoma (ULMS) is a rare malignancy of the female genital tract and carries an extremely poor 5-year survival rate. It is known to metastasize early and to distant sites owing to a high propensity for hematogeneous spread. Lung, peritoneum, liver, and bone are relatively common sites of metastasis. Patient age, tumor size, FIGO stage, and grade of the tumor are important criteria for predicting metastasis. The incidence of ULMS is increasing, probably due to the use of improved imaging techniques and as a result of cancer patients' prolonged life expectancy. An early well thought diagnosis is only made possible if even in otherwise seemingly unsuspected cases, the histopathology slides are extensively screened and the treating clinician is alerted timely. We hereby report a case of an elderly female who underwent hysterectomy for resection of multiple fibroids in the uterus and later presented with distant metastasis to brain with the erosion of overlying skull bone, chest wall, and lungs. Microscopic features along with an extensive immunohistochemistry panel were used to ascertain tumor origin.
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Affiliation(s)
- Arvind Ahuja
- Department of Pathology, Dr. RML Hospital, PGIMER, New Delhi, India
| | - Poojan Agarwal
- Department of Pathology, Dr. RML Hospital, PGIMER, New Delhi, India
| | - Rohan Sardana
- Department of Pathology, Dr. RML Hospital, PGIMER, New Delhi, India
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21
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Roland CL, Boland GM, Demicco EG, Lusby K, Ingram D, May CD, Kivlin CM, Watson K, Al Sannaa GA, Wang WL, Ravi V, Pollock RE, Lev D, Cormier JN, Hunt KK, Feig BW, Lazar AJ, Torres KE. Clinical Observations and Molecular Variables of Primary Vascular Leiomyosarcoma. JAMA Surg 2016; 151:347-54. [PMID: 26629783 DOI: 10.1001/jamasurg.2015.4205] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Vascular leiomyosarcomas are a rare subtype of leiomyosarcomas that most commonly affect the inferior vena cava and account for 5% of all leiomyosarcomas. These tumors are aggressive malignant tumors for which adjuvant modalities have not shown increased efficacy compared with surgery. OBJECTIVES To evaluate the outcomes of patients with vascular leiomyosarcoma and the association between vascular leiomyosarcomas and immunohistochemical molecular markers, to determine their potential prognostic and therapeutic utility. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review of a cohort of 77 patients who presented to the University of Texas MD Anderson Cancer Center in Houston during the period from January 1993 to April 2012. Data were analyzed during the period from November 2012 to May 2015. All of the patients received a confirmed diagnosis of vascular leiomyosarcoma. Immunohistochemical studies for biomarkers were performed on a tissue microarray that included 26 primary specimens of vascular leiomyosarcoma. MAIN OUTCOMES AND MEASURES Demographic and clinical factors were evaluated to assess clinical course, patterns of recurrence, and survival outcomes for patients with primary vascular leiomyosarcoma. A univariate Cox proportional hazards model was used to correlate disease-specific survival and time to recurrence with potential prognostic indicators. RESULTS Sixty-three patients with localized disease who underwent surgical resection formed the study population, and their data were used for subsequent outcomes analysis. The median age at diagnosis was 58 years (range, 22-78 years). The majority of patients were female (41 patients [65%]) and white (51 patients [81%]). The 5-year disease-specific survival rate after tumor resection was 65%. The median time to local recurrence was 43 months, the median time to distant recurrence was 25 months, and the median time to concurrent local and distant recurrences was 15 months (P = .04). Strong expressions of cytoplasmic β-catenin (hazard ratio, 5.33 [95% CI, 0.97-29.30]; P = .06) and insulinlike growth factor 1 receptor (hazard ratio, 2.74 [95% CI, 1.14-6.56]; P = .02) were associated with inferior disease-specific survival. CONCLUSIONS AND RELEVANCE Vascular leiomyosarcomas are aggressive malignant tumors, with high recurrence rates. Expressions of β-catenin and insulinlike growth factor 1 receptor were associated with poor disease-specific survival. Prospective studies should evaluate the clinical and therapeutic utility of these molecular markers.
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Affiliation(s)
- Christina L Roland
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Genevieve M Boland
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston2Department of Surgery, Massachusetts General Hospital, Boston
| | - Elizabeth G Demicco
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston4Department of Pathology, Mount Sinai Hospital, New York, New York
| | - Kristelle Lusby
- Sarcoma Research Center, University of Texas MD Anderson Cancer Center, Houston
| | - Davis Ingram
- Sarcoma Research Center, University of Texas MD Anderson Cancer Center, Houston
| | - Caitlin D May
- Sarcoma Research Center, University of Texas MD Anderson Cancer Center, Houston6Graduate School of Biomedical Sciences, University of Texas Health Science Center at Houston
| | - Christine M Kivlin
- Sarcoma Research Center, University of Texas MD Anderson Cancer Center, Houston6Graduate School of Biomedical Sciences, University of Texas Health Science Center at Houston
| | - Kelsey Watson
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Ghadah A Al Sannaa
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston
| | - Wei-Lien Wang
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston
| | - Vinod Ravi
- Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | | | - Dina Lev
- Sarcoma Research Center, University of Texas MD Anderson Cancer Center, Houston9Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston
| | - Janice N Cormier
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Kelly K Hunt
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Barry W Feig
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Alexander J Lazar
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston
| | - Keila E Torres
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
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22
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Overall Survival and Response to Systemic Therapy in Metastatic Extrauterine Leiomyosarcoma. Sarcoma 2016; 2016:3547497. [PMID: 27313489 PMCID: PMC4903146 DOI: 10.1155/2016/3547497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/18/2016] [Accepted: 03/28/2016] [Indexed: 01/15/2023] Open
Abstract
Background. Leiomyosarcomas (LMS) represent a heterogeneous subset of soft tissue sarcomas. Factors influencing prognosis for patients with metastatic extrauterine LMS (euLMS) are not well described. Limited data are available regarding responses to systemic therapy. Methods. We collected clinical and pathologic information for all patients with metastatic euLMS seen at Memorial Sloan Kettering Cancer Center between 1989 and 2012. Objective responses to first-line therapy were analyzed for a subset of patients with available baseline and on-treatment imaging using RECIST 1.1. Results. 215 patients with metastatic euLMS had a median overall survival (OS) of 2.6 years from the time of metastasis. Older age, male sex, and ≥3 initial sites of metastasis were associated with worse OS on multivariate analysis. Objective response rate (ORR) in N = 113 was 19% overall and 25%, 26%, and 25% for gemcitabine, gemcitabine plus docetaxel, and anthracycline-alkylator combinations. Patients whose tumors objectively responded to first-line therapy had a lower risk of death versus those who did not (Hazard Ratio 0.46; 95% CI: 0.26–0.79, p = 0.005). Conclusions. Anthracycline- and gemcitabine-based regimens have similar activity in this cohort of euLMS. Prognostic factors for OS include older age, male sex, and ≥3 initial sites.
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Kato T, Noda H, Abe I, Alonso S, Yokoyama N, Rikiyama T. Curative resection for leiomyosarcoma of the descending mesocolon with metachronous liver metastasis: A case report and literature review. Mol Clin Oncol 2016; 5:53-56. [PMID: 27330765 DOI: 10.3892/mco.2016.874] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/07/2016] [Indexed: 12/28/2022] Open
Abstract
Mesenteric leiomyosarcoma is a rare disease with poor prognosis. Previously, mesenteric leiomyosarcoma was not differentiated from gastrointestinal stromal tumor (GIST), which is the most common mesenchymal tumor of the gastrointestinal tract, and several cases of GIST may have been misclassified as mesenteric leiomyosarcoma. Thus, the actual clinicopathological characteristics of mesenteric leiomyosarcomas remain unclear. We herein describe a case of leiomyosarcoma arising in the descending mesocolon in a patient who developed metachronous liver metastasis. A 76-year-old woman reported a mass in her left upper abdomen. Computed tomography imaging revealed a low-density tumor adjacent to the descending colon. The patient underwent surgery and the tumor was resected along with part of the descending colon. Immunohistochemical differential diagnosis revealed that the tumor was positive for smooth muscle actin and desmin, and negative for CD117 (c-KIT) and S-100, which are characteristic of gastrointestinal leiomyosarcoma. A single liver metastasis developed 24 months after the operation. The patient underwent curative resection of the metastatic lesion. Sixteen months following surgery for the liver metastasis and 40 months after the initial removal of the primary lesion, the patient remains disease-free. The prognosis of leiomyosarcoma remains poor and standardized chemotherapy for this rare disease has not yet been established. Early diagnosis and surgical removal of the tumor is the only potentially curative option for liver metastasis of mesenteric leiomyosarcoma.
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Affiliation(s)
- Takaharu Kato
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama 330-8503, Japan; Institute of Predictive and Personalized Medicine of Cancer (IMPPC), Health Sciences Research Institute Germans Trias i Pujol (IGTP), Campus Can Ruti, 08916 Badalona, Barcelona, Spain
| | - Hiroshi Noda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama 330-8503, Japan
| | - Iku Abe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama 330-8503, Japan
| | - Sergio Alonso
- Institute of Predictive and Personalized Medicine of Cancer (IMPPC), Health Sciences Research Institute Germans Trias i Pujol (IGTP), Campus Can Ruti, 08916 Badalona, Barcelona, Spain
| | - Nobu Yokoyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama 330-8503, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama 330-8503, Japan
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Metastatic mesenteric dedifferentiated leiomyosarcoma: a case report and a review of literature. Clin Sarcoma Res 2016; 6:2. [PMID: 26913180 PMCID: PMC4765132 DOI: 10.1186/s13569-016-0042-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/12/2016] [Indexed: 11/12/2022] Open
Abstract
Background Abdominal leiomyosarcoma arising from the mesentery is a rare malignancy. It is an aggressive entity with an overall 5 year survival rate between 20 and 30 %. Surgical resection is the cornerstone of primary treatment and may be curative for localized disease. However, patients often develop intra-abdominal relapse and/or metastatic disease. If surgical resection is not feasible, palliative chemotherapy is the treatment of choice. However, there are no clear guidelines regarding chemotherapy; neither in the adjuvant nor advanced setting. Case presentation We present a 40 year-old woman, with a mesenteric leiomyosarcoma, who underwent radical tumor resection and did not receive adjuvant oncological therapy. Three months postoperatively, she developed metastatic disease to the lungs and liver. After multidisciplinary assessment she received an unconventional histological-subtype-tailored chemotherapy comprising 3–4 regimens. Initially, there was a decrease both in number and size of metastases. Ultimately, an almost complete radiological response was seen. Subsequent surgical resection and radiofrequency ablation of residual metastatic foci in the liver and lung brought her into complete clinical remission. She is presently tumor free, 36 months following diagnosis of metastatic disease. Conclusions To our knowledge, this is the first report of a patient with metastatic mesenteric leiomyosarcoma who is in complete clinical and radiological long-term remission following very aggressive multimodal treatment; including intense poly-drug chemotherapy and without any demonstrable long-term side effects. Given the rarity of mesenteric leiomyosarcoma and lack of guidelines regarding oncological therapy, we suggest that multimodal therapy including aggressive chemotherapy, guided by a multidisciplinary team, is essential to achieve an optimal outcome.
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Duffaud F, Ray-Coquard I, Salas S, Pautier P. Recent advances in understanding and managing leiomyosarcomas. F1000PRIME REPORTS 2015; 7:55. [PMID: 26097728 PMCID: PMC4447031 DOI: 10.12703/p7-55] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Leiomyosarcomas are malignant mesenchymal tumours that derive from the smooth muscle lineage. They are studied and frequently treated as if they are the same as other soft tissue sarcomas. Recent developments suggest that a different approach may be more appropriate. Their underlying genetic mechanisms remain unclear, and complex. Unbalanced karyotypic defects are the only shared features observed across different leiomyosarcoma subtypes. Unlike other soft tissue sarcomas, leiomyosarcomas are particularly sensitive to the combination of gemcitabine and docetaxel. Furthermore, treatment with trabectedin has shown a good efficacy in leiomyosarcomas, mainly in the form of chronic disease stabilisation.
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Affiliation(s)
- Florence Duffaud
- Aix Marseille Université (AMU), Service d'Oncologie médicaleCHU la Timone Boulevard J Moulin 13005 MarseilleFrance
| | - Isabelle Ray-Coquard
- Université Claude Bernard Lyon I, Oncologie Médicale, Centre Leon Bérard28 rue Laennec, 69008 LyonFrance
| | - Sébastien Salas
- Aix Marseille Université (AMU), Service d'Oncologie médicaleCHU la Timone Boulevard J Moulin 13005 MarseilleFrance
| | - Patricia Pautier
- Gustave Roussy Cancer Campus114 Rue E Vaillant, 94805 VillejuifFrance
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Reichardt P. Soft tissue sarcomas, a look into the future: different treatments for different subtypes. Future Oncol 2015; 10:s19-27. [PMID: 25048045 DOI: 10.2217/fon.14.116] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Soft tissue sarcomas (STS) are a heterogeneous group of rare malignancies frequently studied and treated as if they were one and the same disease. Evidence is emerging that distinct histopathological differences between the subtypes can significantly impact on optimal management of patients with STS. For the majority of patients with localized disease, surgery is the treatment of choice, sometimes combined with radiotherapy. For patients with advanced/refractory disease, there are a number of options. The first option is to consider cytotoxic chemotherapy with doxorubicin ± ifosfamide to reduce tumor size and make the tumor more amenable to surgery. If this is not possible, treatment should be aimed at reducing symptoms, improving patients' wellbeing and prolonging life. In this regard, understanding of the different biologies and sensitivities of the various histological subtypes of STS continues to expand, and an increasing number of targeted therapies are becoming available. Examples of more specific treatment options include taxanes in angiosarcoma, and trabectedin in leiomyosarcoma, liposarcoma and undifferentiated pleomorphic sarcoma. Although much remains to be learned about these rare malignancies, it is anticipated that small steps taken in recent years will lead to bigger leaps forward in future.
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Affiliation(s)
- Peter Reichardt
- HELIOS Klinikum Berlin-Buch, Department of Interdisciplinary Oncology, Schwanebecker Chaussee 50, 13125 Berlin, Germany.
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Pautier P, Floquet A, Chevreau C, Penel N, Guillemet C, Delcambre C, Cupissol D, Selle F, Isambert N, Piperno-Neumann S, Thyss A, Bertucci F, Bompas E, Alexandre J, Collard O, Lavau-Denes S, Soulié P, Toulmonde M, Le Cesne A, Lacas B, Duffaud F. Trabectedin in combination with doxorubicin for first-line treatment of advanced uterine or soft-tissue leiomyosarcoma (LMS-02): a non-randomised, multicentre, phase 2 trial. Lancet Oncol 2015; 16:457-64. [PMID: 25795402 DOI: 10.1016/s1470-2045(15)70070-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Metastatic leiomyosarcomas of uterine or soft-tissue origin have poor prognosis and moderate chemosensitivity. Trabectedin has shown activity in pretreated leiomyosarcoma. We did a single-group, multicentre, phase 2 trial (LMS-02) to assess the effect of first-line doxorubicin and trabectedin combination on disease control and survival. METHODS Adults (18 years to physiological age ≤70 years) with measurable metastatic or unresectable uterine leiomyosarcoma or soft-tissue leiomyosarcoma who had not received any previous chemotherapy were enrolled at 19 centres in France. Treatment consisted of 60 mg/m(2) intravenous doxorubicin followed by 1·1 mg/m(2) trabectedin in a 3 h intravenous infusion on day 1, both by the central venous route, and 6 mg subcutaneous pegfilgrastim on day 2, repeated every 3 weeks for up to six cycles. Surgery for residual disease was permitted. The primary endpoint was the proportion of patients achieving disease control, defined as complete or partial response or stable disease. Stratification was done by anatomical site and analyses were per protocol. This study is registered with ClinicalTrials.gov, number NCT02131480. FINDINGS Between July 28, 2010, and May 10, 2013, 109 patients were enrolled and treated, of whom 108 were assessable for response: 47 in the uterine leiomyosarcoma group and 61 in the soft-tissue leiomyosarcoma group. 32 (68%) patients in the uterine leiomyosarcoma group and 45 (74%) in the soft-tissue leiomyosarcoma group received all six cycles of treatment. Of 47 patients with uterine leiomyosarcoma, 28 (59·6%, 95% CI 44·3-73·6) achieved a partial response and 13 (27·7%, 15·6-42·6) stable disease; 41 (87·2%, 74·3-95·2) patients achieved disease control. Of 61 patients with soft-tissue leiomyosarcoma, two (3·3%, 95% CI 0·4-11·7) achieved a complete response, 22 (36·1%, 25·0-50·8) had a partial response, and 32 (52·5%, 40·8-67·3) had stable disease; 56 (91·8%, 81·9-97·3) of patients achieved disease control. The most common grade 3-4 treatment-associated adverse events were neutropenia (84 [78%] of 108 patients), increased alanine aminotransferase concentration (42 [39%]), thrombocytopenia (40 [37%]), anaemia (29 [27%]), febrile neutropenia (26 [24%]), and fatigue (21 [19%]). INTERPRETATION Despite expected but manageable toxic effects, these results support the activity of doxorubicin plus trabectedin as first-line treatment for uterine leiomyosarcoma and soft-tissue leiomyosarcoma. This combination should be developed further in a phase 3 trial against the present standard of care. FUNDING Pharmamar and Amgen.
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Affiliation(s)
- Patricia Pautier
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France.
| | - Anne Floquet
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Christine Chevreau
- Department of Medical Oncology, Institut Claudius-Regaud, Toulouse, France
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar-Lambret, Lille, France
| | - Cécile Guillemet
- Department of Medical Oncology, Centre Henri-Becquerel, Rouen, France
| | - Corinne Delcambre
- Department of Medical Oncology, Centre François-Baclesse, Caen, France
| | - Didier Cupissol
- Department of Medical Oncology, Centre Val d'Aurelle, Montpellier, France
| | - Frédéric Selle
- Department of Medical Oncology, Hôpital Tenon, Paris, France
| | - Nicolas Isambert
- Department of Medical Oncology, Centre GF Leclerc, Dijon, France
| | | | - Antoine Thyss
- Department of Medical Oncology Centre Antoine Lacassagne, Nice, France
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Emmanuelle Bompas
- Department of Medical Oncology, Centre René Gauducheau, Saint Herblain, France
| | | | - Olivier Collard
- Department of Medical Oncology, Institut de Cancérologie de la Loire, Saint Priest en Jarez, France
| | - Sandrine Lavau-Denes
- Department of Medical Oncology, Centre Hospitalo-Universitaire Dupuytren, Limoges, France
| | - Patrick Soulié
- Department of Medical Oncology, Centre Paul Papin, Angers, France
| | - Maud Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Axel Le Cesne
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Benjamin Lacas
- Department of Biostatistics, Institut Gustave Roussy, Villejuif, France
| | - Florence Duffaud
- Department of Medical Oncology, La Timone University Hospital, Marseille, France
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28
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Liebner DA. The indications and efficacy of conventional chemotherapy in primary and recurrent sarcoma. J Surg Oncol 2015; 111:622-31. [DOI: 10.1002/jso.23866] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/13/2014] [Indexed: 01/13/2023]
Affiliation(s)
- David A. Liebner
- Department of Internal Medicine; Division of Medical Oncology; The Ohio State University; Columbus Ohio
- Department of Biomedical Informatics; Division of Computational Biology and Bioinformatics; The Ohio State University; Columbus Ohio
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[Uterine leiomyosarcoma: epidemiology, pathology, biology, diagnosis, prognosis and treatment]. Bull Cancer 2013; 100:903-15. [PMID: 24004576 DOI: 10.1684/bdc.2013.1801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Uterine leiomyosarcoma is a rare disease with a poor prognosis. The rarity of this tumor needs a specialized management in tertiary reference centers in order to provide patients with optimal diagnostic, prognostic and therapeutic care. The pathological diagnosis relies on the presence of three characteristics in proliferating smooth muscle cells: necrosis, cytologic atypia and mitosis. Despite progress in the knowledge of the biology of these tumors, no oncogenic driver has been found. Prognosis depends mainly on the age of the patient, race, FIGO stage, mitotic index and hormonal receptor expression in the tumor. Surgery is one of the cornerstones of management and cytotoxic chemotherapy is the mainstay of treatment in metastatic disease with a potential role in the adjuvant setting. In locally advanced or metastatic disease, prognosis is poor with a median overall survival of about 12 to 14 months despite a 30% response rate to polychemotherapy regimens. Anti-angiogenics and hormonal therapy have a role to play in the setting of metastatic disease. It is mandatory to include such patients in clinical trials aiming to improve the therapeutic management of these patients. Multimodal therapy can improve the prognosis of selected patients too.
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30
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George S, Feng Y, Manola J, Nucci MR, Butrynski JE, Morgan JA, Ramaiya N, Quek R, Penson RT, Wagner AJ, Harmon D, Demetri GD, Krasner C. Phase 2 trial of aromatase inhibition with letrozole in patients with uterine leiomyosarcomas expressing estrogen and/or progesterone receptors. Cancer 2013; 120:738-43. [PMID: 24222211 DOI: 10.1002/cncr.28476] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/09/2013] [Accepted: 10/11/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Advanced uterine leiomyosarcoma (ULMS) is an incurable disease. A significant percentage of cases of ULMS express estrogen and/or progesterone receptors (ER and/or PR). To the authors' knowledge, the role of estrogen suppression in disease management is not known. METHODS The authors performed a single-arm phase 2 study of the aromatase inhibitor letrozole at a dose of 2.5 mg daily in patients with unresectable ULMS with ER and/or PR expression confirmed by immunohistochemistry. Tumor assessments were performed at baseline, 6 weeks, 12 weeks, and every 8 weeks thereafter. Toxicity was monitored throughout treatment. The primary endpoint was the progression-free survival at 12 weeks. RESULTS A total of 27 patients was accrued, with a median of 2 prior treatment regimens (range, 0-9 treatment regimens). The median duration of protocol treatment was 2.2 months (range, 0.4 months-9.9 months). The 12-week progression-free survival rate was 50% (90% confidence interval, 30%-67%). The best response was stable disease in 14 patients (54%; 90% CI, 36%-71%). Three patients, all of whom had tumors expressing ER and PR in > 90% of tumor cells, continued to receive letrozole for > 24 weeks. The most common reason for treatment discontinuation was disease progression (85%). Letrozole was found to be well tolerated. CONCLUSIONS Letrozole met protocol-defined criteria as an agent with activity in patients with advanced ULMS. Patients with the longest progression-free survival rate were those whose tumors strongly and diffusely expressed ER and PR.
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Affiliation(s)
- Suzanne George
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Sette G, Salvati V, Memeo L, Fecchi K, Colarossi C, Di Matteo P, Signore M, Biffoni M, D’Andrea V, De Antoni E, Canzonieri V, De Maria R, Eramo A. EGFR inhibition abrogates leiomyosarcoma cell chemoresistance through inactivation of survival pathways and impairment of CSC potential. PLoS One 2012; 7:e46891. [PMID: 23056514 PMCID: PMC3466184 DOI: 10.1371/journal.pone.0046891] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 09/10/2012] [Indexed: 01/06/2023] Open
Abstract
Background Tumor cells with stem-like phenotype and properties, known as cancer stem cells (CSC), have been identified in most solid tumors and are presumed to be responsible for driving tumor initiation, chemoresistance, relapse, or metastasis. A subpopulation of cells with increased stem-like potential has also been identified within sarcomas. These cells are endowed with increased tumorigenic potential, chemoresistance, expression of embryonic markers, and side population(SP) phenotype. Leiomyosarcomas (LMS) are soft tissue sarcomas presumably arising from undifferentiated cells of mesenchymal origin, the Mesenchymal Stem Cells (MSC). Frequent recurrence of LMS and chemoresistance of relapsed patients may likely result from the failure to target CSC. Therefore, therapeutic cues coming from the cancer stem cell (CSC) field may drastically improve patient outcome. Methodology/Principal Findings We expanded LMS stem-like cells from patient samples in vitro and examined the possibility to counteract LMS malignancy through a stem-like cell effective approach. LMS stem-like cells were in vitro expanded both as “tumor spheres” and as “monolayers” in Mesenchymal Stem Cell (MSC) conditions. LMS stem-like cells displayed MSC phenotype, higher SP fraction, and increased drug-extrusion, extended proliferation potential, self-renewal, and multiple differentiation ability. They were chemoresistant, highly tumorigenic, and faithfully reproduced the patient tumor in mice. Such cells displayed activation of EGFR/AKT/MAPK pathways, suggesting a possibility in overcoming their chemoresistance through EGFR blockade. IRESSA plus Vincristine treatment determined pathway inactivation, impairment of SP phenotype, high cytotoxicity in vitro and strong antitumor activity in stem-like cell-generated patient-like xenografts, targeting both stem-like and differentiated cells. Conclusions/Significance EGFR blockade combined with vincristine determines stem-like cell effective antitumor activity in vitro and in vivo against LMS, thus providing a potential therapy for LMS patients.
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Affiliation(s)
- Giovanni Sette
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Valentina Salvati
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | | | - Katia Fecchi
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | | | - Paola Di Matteo
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Michele Signore
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Mauro Biffoni
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Vito D’Andrea
- Department of Surgical Sciences, La Sapienza University of Rome, Italy
| | - Enrico De Antoni
- Department of Surgical Sciences, La Sapienza University of Rome, Italy
| | - Vincenzo Canzonieri
- Division of Pathology, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Italy
| | | | - Adriana Eramo
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
- * E-mail:
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Pautier P, Floquet A, Penel N, Piperno-Neumann S, Isambert N, Rey A, Bompas E, Cioffi A, Delcambre C, Cupissol D, Collin F, Blay JY, Jimenez M, Duffaud F. Randomized multicenter and stratified phase II study of gemcitabine alone versus gemcitabine and docetaxel in patients with metastatic or relapsed leiomyosarcomas: a Federation Nationale des Centres de Lutte Contre le Cancer (FNCLCC) French Sarcoma Group Study (TAXOGEM study). Oncologist 2012; 17:1213-20. [PMID: 22907974 DOI: 10.1634/theoncologist.2011-0467] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the efficacy and toxicity of single-agent gemcitabine versus gemcitabine plus docetaxel as second-line therapy in patients with uterine and nonuterine leiomyosarcoma (LMS). PATIENTS AND METHODS Patients had metastatic or unresectable LMS and had received one prior anthracycline-based regimen. A total of 90 patients received either single-agent gemcitabine (arm A; gemcitabine, 1,000 mg/m(2) i.v. for 100 minutes on days 1, 8, and 15 of a 28-day cycle) or a combination of gemcitabine and docetaxel (arm B; gemcitabine, 900 mg/m(2) i.v. for 90 minutes on days 1 and 8, plus docetaxel, 100 mg/m(2) i.v. for 1 hour on day 8 of a 21-day cycle with lenograstim). The primary endpoint was the objective response rate. RESULTS The objective response rates were 19% and 24% in arm A (gemcitabine) and arm B (gemcitabine plus docetaxel), respectively, for patients with uterine LMS. For patients with nonuterine LMS, the objective response rates were 14% and 5% for arms A and B, respectively. The median progression-free survival times for arms A and B were 5.5 months and 4.7 months, respectively, for patients with uterine LMS. For patients with nonuterine LMS, the median progression-free survival times were 6.3 months and 3.8 months for arms A and B, respectively. One toxic death occurred in arm B. CONCLUSIONS Both single-agent gemcitabine and gemcitabine plus docetaxel were found to be effective second-line therapies for leiomyosarcomas, with a 3-month progression-free survival rate of 40% for LMS with both uterine and nonuterine sites of origin. Single-agent gemcitabine yielded results similar to those of gemcitabine plus docetaxel in this trial, but patients using single-agent gemcitabine experienced less toxicity.
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Affiliation(s)
- Patricia Pautier
- Institut Gustave-Roussy, 114 rue Edouard Vaillant, Villejuif, France.
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Repeated and aggressive pulmonary resections for leiomyosarcoma metastases extends survival. Ann Thorac Surg 2011; 92:1202-7. [PMID: 21867989 DOI: 10.1016/j.athoracsur.2011.05.052] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 05/13/2011] [Accepted: 05/16/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sarcoma frequently metastasizes to the lungs, and pulmonary metastasectomy is the only treatment modality that can provide a cure for these patients. We attempted to determine the clinicopathologic features and survival determinants of a common subset of patients who undergo pulmonary metastasectomy for leiomyosarcoma. METHODS All patients undergoing pulmonary metastasectomy at The Brigham and Women's Hospital from 1989 to 2004 were reviewed retrospectively. Analyzed variables included number, size, pathology, and location of metastases, age, gender, location of primary tumor, disease-free interval (DFI), surgical approach, margin status, adjuvant therapy, recurrence, number of metastasectomies, and disease-free and overall survival. RESULTS Eighty-two patients underwent pulmonary metastasectomy for metastases from sarcoma. Leiomyosarcoma was the most common histologic finding (n = 31; 38%). Fifteen patients with leiomyosarcoma (48%) underwent repeated pulmonary metastasectomy. Patients with leiomyosarcoma were more commonly female (77% versus 43%; p = 0.031), less frequently received chemotherapy for their primary tumor (48% versus 71%, p = 0.041), and presented with fewer number of pulmonary metastases than did patients with nonleiomyosarcoma metastases (1.9 ± 1.5 standard deviation [SD] versus 3.6 ± 4.4; p = 0.033). Although there was no difference in disease-free survival, patients with leiomyosarcoma demonstrated improved overall survival compared with those with nonleiomyosarcoma metastases (70 versus 24 months; p = 0.049). In multivariate analyses, the DFI from primary tumor resection to pulmonary metastases and the DFI from pulmonary metastasectomy to second pulmonary recurrence were identified as independent predictors of survival. CONCLUSIONS Leiomyosarcoma is a common subset of sarcomatous pulmonary metastases that behave more indolently compared with other pulmonary metastases from sarcoma. Long-term survival is achievable with an aggressive approach toward pulmonary metastasectomy and repeated pulmonary metastasectomy.
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Penel N, Italiano A, Ray-Coquard I, Chaigneau L, Delcambre C, Robin YM, Bui B, Bertucci F, Isambert N, Cupissol D, Bompas E, Bay JO, Duffaud F, Guillemet C, Blay JY. Metastatic angiosarcomas: doxorubicin-based regimens, weekly paclitaxel and metastasectomy significantly improve the outcome. Ann Oncol 2011; 23:517-23. [PMID: 21566149 DOI: 10.1093/annonc/mdr138] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Angiosarcomas are a rare but aggressive form of soft tissue sarcoma. At metastatic stage, the clinical benefit of therapeutic intervention remains debatable. PATIENTS AND METHODS We have carried a retrospective analysis of 149 cases treated between 1996 and 2009 in the French Sarcoma Group. RESULTS The median age was 60; the sex ratio was 0.80. Sixty-two percentage of cases presented with metastasis at the diagnosis. About 20% arose in irradiated fields. The median overall survival was 11 months. Treatment consisted in metastasectomy (5.4%), doxorubicin-based regimen (46.9%), weekly paclitaxel (Taxol) (31.5%), other chemotherapy regimens (10.7%) or exclusive palliative care (10.9%). Clinical prognostic factors identified by univariate analysis were presence of bone metastasis (P = 0.0107), presence of other metastasis (P = 0.0327) and performance status (P < 0.0001). The Cox model retained a performance status of two or more as the sole independent prognostic factor (HR [hazard ratio] = 2.49, P < 0.0001). After adjustment to the performance status and compared with exclusive palliative care, the following treatments significantly improve the outcome: doxorubicin-based regimen as first-line chemotherapy (HR = 0.38, P = 0.0165), weekly paclitaxel as first-line regimen (HR = 0.36, P = 0.0146) and metastasectomy (HR = 0.09, P = 0.0221). CONCLUSIONS This retrospective analysis indicates that some therapeutic interventions may significantly improve the outcome of this aggressive disease. Doxorubicin-based regimens and weekly paclitaxel seem to provide the same range of efficacy.
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Affiliation(s)
- N Penel
- Sarcoma Unit, Department of General Oncology, Centre Oscar Lambret, Lille, France.
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De Pas T, Rosati G, Spitaleri G, Boni C, Tucci A, Frustaci S, Scalamogna R, Radice D, Boselli S, Toffalorio F, Catania C, Noberasco C, Delmonte A, Vecchio F, de Braud F. Optimizing Clinical Care in Patients with Advanced Soft Tissue Sarcoma: A Phase II Study of a New Schedule of High-Dose Continuous Infusion Ifosfamide and Doxorubicin Combination. Chemotherapy 2011; 57:217-24. [DOI: 10.1159/000326466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 12/06/2010] [Indexed: 12/27/2022]
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