Outcomes of First-Line Chemotherapy in Patients with Advanced or Metastatic Leiomyosarcoma of Uterine and Non-Uterine Origin

Abstract

Although leiomyosarcomas (LMSs) form the largest subgroup of soft tissue sarcomas (STSs), the efficacy of chemotherapy in this group is largely unclear, partly because older studies are contaminated with gastrointestinal stromal tumors (GISTs). In this retrospective study we investigated the outcome of first line chemotherapy in 65 patients with unresectable or metastatic LMS. The overall response rate (ORR) was 18%; and the median progression-free (PFS) and overall survival (OS) were 3.8 and 9.7 months respectively. No statistically significant differences in outcomes for uterine and non-uterine LMS were found. In non-uterine LMS, however, the PFS and OS seemed to be longer for females than for males, potentially negatively affecting outcomes in this group. If our observations are confirmed in other series, they would suggest that studies performed in STS patients should not only stratify for histological subtype but also for uterine versus non-uterine LMS and for gender.

Retrospective Analysis of Outcome of Patients with Metastatic Leiomyosarcoma in a Tertiary Referral Center

“…Patient demographics are in line with data reported previously [9][10][11][12]. Of note, the number of patients with primary uterine LMS is slightly lower in our series than in series reported previously, probably due to a referral bias.…”

“…Of note, the number of patients with primary uterine LMS is slightly lower in our series than in series reported previously, probably due to a referral bias. Response rates to first-line palliative systemic therapies in our series, with an ORR of 20% and an additional 42% of patients achieving SD, match previously reported data [9][10][11][12][13]. In a recent retrospective analysis of 190 patients with advanced/metastatic uterine LMS treated in 13 different European clinical trials, the ORR to first-line palliative treatment was 19% [13].…”

“…However, most patients in the North American cohort were treated with a gemcitabine-containing regimen in first line (42%, 47/112). The median PFS to firstline palliative systemic therapy in our series is higher than the PFS reported by Shoustari et al [10] and Oosten et al [9], who reported a PFS of 3.3 and 3.8 months, respectively, compared with 4.9 months in our series. Responses to later lines of systemic therapies are rare [15][16][17][18][19][20]21].…”

“…Anthracyclinecontaining regimens, with or without an alkylating agent, are commonly used. Responses to systemic therapies have primarily been published in various smaller and larger retrospective case series, with response rates to first-line systemic therapy ranging from 19% to 33% [9][10][11][12][13]. In second and later lines, multiple cytotoxic and targeted agents, such as dacarbazine, docetaxel, eribulin, gemcitabine, ifosfamide, pazopanib and trabectedin are used [14][15][16][17][18][19][20][21][22][23].…”

Primary hepatic leiomyosarcoma: Case report and literature review

“…Adjuvant chemotherapy in the form of doxorubicin and ifosfamide seems to slow the course of the disease and may prolong survival in R1 resections but the evidence is lacking as the data are extrapolated from the unresectable or metastatic leiomyosarcoma setting [18] . Liver transplant has been attempted sporadically in primary hepatic leiomyosarcoma but is not as welldefined as in the setting of primary hepatic epithelioid hemangioendothelioma [19] .…”