Impact of chemotherapy in uterine sarcoma (UtS): review of 13 clinical trials from the EORTC Soft Tissue and Bone Sarcoma Group (STBSG) involving advanced/metastatic UtS compared to other soft tissue sarcoma (STS) patients treated with first line chemotherapy

Abstract Objective UtS are a group of uncommon tumors representing 1% of malignant neoplasms of the female genital tract, and 7% of sarcomas. The objective of this study was to evaluate the factors associated with the clinical behavior UtS. Methods Information on 269 patients with advanced or metast...

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Published in:Gynecologic oncology 2016-07, Vol.142 (1), p.95-101
Main Authors: Ray-Coquard, I, Rizzo, E, Blay, J.Y, Casali, P, Judson, I, Hansen, A. Krarup, Lindner, L.H, dei Tos, A.P, Gelderblom, H, Marreaud, S, Litière, S, Rutkowski, P, Hohenberger, P, Gronchi, A, van der Graaf, W.T
Format: Article
Language:English
Subjects:
Adult
Chemotherapy
Female
Hematology, Oncology and Palliative Medicine
Humans
Leiomyosarcoma - drug therapy
Leiomyosarcoma - pathology
Middle Aged
Neoplasm Staging
Obstetrics and Gynecology
Prognosis
Randomized Controlled Trials as Topic
Sarcoma
Sarcoma - drug therapy
Sarcoma - pathology
Survival Rate
Treatment
Uterine
Uterine Neoplasms - drug therapy
Uterine Neoplasms - pathology
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Summary:Abstract Objective UtS are a group of uncommon tumors representing 1% of malignant neoplasms of the female genital tract, and 7% of sarcomas. The objective of this study was to evaluate the factors associated with the clinical behavior UtS. Methods Information on 269 patients with advanced or metastatic first line UtS treated by chemotherapy was available in a database containing information on 3270 patients with advanced soft tissue sarcomas (STS) entered in EORTC-STBSG clinical trials between 1977 and 2010. The chemotherapy was aggregated in 4 categories: anthracyclines alone, ifosfamide alone, the combination of doxorubicin and ifosfamide, and CYVADIC. Results Among the 269 UtS pts, there were 231 deaths (median OS 10.4 months, 95% CI: 9.1–11.9) and 257 progressions and/or deaths (median PFS 4.1 months, 95% CI: 3.5–4.9). Multivariate analyses reported PS (p < 0.001) only to be a statistically significant prognostic factor for OS in UtS; for PFS, LMS histology (p = 0.025) is associated with a better outcome. There was no relationship between the 4 groups of chemotherapy regimens and impact on clinical outcomes. Histological subtype was significantly correlated with response to chemotherapy (RR: LMS 19% vs other 33%, p = 0.026). Ifosfamide single agent yielded only 5% of RR. Conclusions Clearly, UtS are very aggressive neoplasms with poor outcome when treated with chemotherapy consisting of anthracyclines with or without ifosfamide or cyclophosphamide. New strategies are urgently needed.
ISSN:0090-8258
1095-6859
DOI:10.1016/j.ygyno.2016.05.016