Systemic Treatment of Metastatic/Recurrent Uterine Leiomyosarcoma: A Changing Paradigm. (23rd August 2018)

• Record Type: Journal Article
• Authors: Arend, Rebecca C.; Toboni, Michael D.; Montgomery, Allison M.; Burger, Robert A.; Olawaiye, Alexander B.; Monk, Bradley J.; Herzog, Thomas J.
• Is Part Of: Oncologist. Volume 23:Number 12(2018)
• Page Start: 1533
• Page End: 1545
• Publication Date: 2018-08-23
• Subjects: Uterine cancer -- Leiomyosarcoma -- Soft tissue sarcoma -- Uterine sarcoma -- L‐sarcoma chemotherapy; Oncology -- Periodicals; Tumors -- Periodicals; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Oncology; Tumors; Neoplasms; Electronic journals; Periodicals; Periodicals; 616.994
• DOI: 10.1634/theoncologist.2018-0095
• Languages: English
• ISSNs: 1083-7159

Abstract

Abstract: : The treatment of metastatic and recurrent uterine leoimyosarcoma (uLMS) has evolved rapidly in the past several years. Leoimyosarcoma is extremely aggressive and responds poorly to traditional chemotherapeutics. Recent regulatory approval of novel treatment options has significantly expanded the therapeutic armamentarium, and the addition of these therapies has challenged clinicians to select and optimally sequence these new compounds. Additionally, the potential role of immunotherapy is being assessed in current uLMS clinical trials. Given the increasing number of agents available both in the U.S. and globally, a treatment template that addresses optimal sequencing based upon expert consensus would be useful. Current guidelines, although listing various options, lack granularity by line of therapy. Most patients with leiomyosarcoma, even in early stage, are treated with surgery followed by adjuvant chemotherapy despite uLMS being relatively chemoresistant. Adjuvant chemotherapy often includes the combination of gemcitabine and docetaxel with or without doxorubicin in first‐line systemic therapy, but these cytotoxic agents only provide patients with advanced disease a 5‐year survival <30%. This review will focus on examination of current guidelines and consensus building for optimal sequencing of systemic therapies for advanced or recurrent uLMS. Critical ongoing studies investigating novel approaches including immunotherapeutics and genetic alterations also will be discussed. Implications for Practice: Recent regulatory approval of novel treatment options has significantly expanded the therapeutic armamentarium, and the addition of these therapies has challenged clinicians to select and optimally sequence these compounds. This review will focus on examination of current guidelines and consensus building for optimal sequencing of systemic therapies for advanced or recurrent uterine leoimyosarcoma. Abstract : Leoimyosarcoma is aggressive and responds poorly to chemotherapy. Novel treatment options are now available, but the challenge is the selection and optimal use of these new therapies. This review examines current guidelines to build consensus for optimal treatment guidelines for advanced or recurrent uterine leiomyosarcoma.