Survival outcome of women with stage IV uterine carcinosarcoma who received neoadjuvant chemotherapy followed by surgery

Matsuo, Koji; Johnson, Marian S.; Im, Dwight D.; Ross, Malcolm S.; Bush, Stephen H.; Yunokawa, Mayu; Blake, Erin A.; Takano, Tadao; Klobocista, Merieme; Ueda, Yutaka; Shida, Masako; Baba, Tsukasa; Satoh, Shinya; Yokoyama, Tadashi; Machida, Hiroko; Ikeda, Yuji; Adachi, Sosuke; Miyake, Takahito; Iwasaki, Keita; Yanai, Shiori; Takeuchi, Satoshi; Nishimura, Masato; Nagano, Tadayoshi; Takekuma, Munetaka; Shahzad, Mian M.K.; Pejović, Tanja; Omatsu, Kohei; Kelley, Joseph L.; Ueland, Frederick R.; Roman, Lynda D.

doi:10.1002/jso.24861

Cited by 15 publications

(6 citation statements)

References 26 publications

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“…In the only available retrospective cohort study of patients receiving neoadjuvant therapy for a stage IV UCS, with carboplatin/paclitaxel being the most commonly used regiments, there was no statistically significant difference in survival compared with patients who underwent surgery first. 17 To the best of our knowledge, our case represents the first case with a stage II UCS receiving neoadjuvant therapy with promising results.…”

Section: Discussionmentioning

confidence: 68%

“… 15 The role of neoadjuvant chemotherapy has been studied in various types of gynecological malignancy, including ovarian and high-grade endometrial cancers. 15 16 17 However, the effectiveness of neoadjuvant chemotherapy in UCS has not been studied, likely due to the rarity of disease. In the only available retrospective cohort study of patients receiving neoadjuvant therapy for a stage IV UCS, with carboplatin/paclitaxel being the most commonly used regiments, there was no statistically significant difference in survival compared with patients who underwent surgery first.…”

Section: Discussionmentioning

confidence: 99%

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Primary Cervical Carcinosarcoma: Report of a Rare Case

et al. 2022

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Background Carcinosarcomas are malignant mixed Müllerian tumors (MMMT), containing both epithelial and mesenchymal components. Carcinosarcomas of the uterine cervix comprise an extremely rare histopathological entity, with less than 150 cases reported in the literature to date. Materials and Methods A 79-year-old postmenopausal female patient was referred to our gynecological department due to a pelvic mass and vaginal bleeding. A cervical curettage was performed and the histological report revealed a malignant neoplasm with high cellularity consisting of two components; the first was a chondrosarcoma and the latter a adenocarcinoma. A diagnosis of MMMT was confirmed through immunohistochemical (IHC) staining. Neoadjuvant chemotherapy and radiotherapy were implemented, and a year later the patient underwent a radical hysterectomy and oncological pelvic lymph node dissection. She remains disease-free 12 months postoperatively. Conclusion Primary cervical carcinosarcomas are extremely rare tumors demonstrating a bipartite profile. Preoperative diagnosis with appropriate immunochemistry testing of this rare entity is crucial to decision making.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Primary Cervical Carcinosarcoma: Report of a Rare Case

et al. 2022

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“…Retrospective studies suggest that suboptimal debulking does not confer additional survival benefit over chemotherapy alone in endometrial carcinosarcomas, thus thorough patient selection is key, and surgery should be pursued only if complete macroscopic resection can be achieved 9 28. A few small studies have also investigated the potential role of neoadjuvant protocols, such as platinum-based chemotherapy or concurrent chemoradiotherapy, to increase complete resection rates, reporting interesting results warranting prospective large-scale validation 29 30. Ovarian preservation and fertility-sparing surgery are not recommended for endometrial carcinosarcoma 7 9…”

Section: Standard Treatmentmentioning

confidence: 99%

Endometrial carcinosarcoma

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Ray‐Coquard

Concin

et al. 2022

Int J Gynecol Cancer

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Endometrial carcinosarcoma is a rare and aggressive high-grade endometrial carcinoma with secondary sarcomatous trans-differentiation (conversion theory). The clinical presentation and diagnostic work-up roughly align with those of the more common endometrioid counterpart, although endometrial carcinosarcoma is more frequently diagnosed at an advanced stage. Endometrial carcinosarcoma is not a single entity but encompasses different histological subtypes, depending on the type of carcinomatous and sarcomatous elements. The majority of endometrial carcinosarcomas are characterized by p53 abnormalities. The proportion ofPOLEand microsatellite instablity-high (MSI-H) is directly related to the epithelial component, being approximately 25% and 3% in endometrioid and non-endometrioid components.The management of non-metastatic disease is based on a multimodal approach with optimal surgery followed by (concomitant or sequential) chemotherapy and radiotherapy, even for early stages. Palliative chemotherapy is recommended in the metastatic or recurrent setting, with carboplatin/paclitaxel doublet being the first-line regimen. Although the introduction of immunotherapy plus/minus a tyrosine kinase inhibitor shifted the paradigm of treatment of patients with recurrent endometrial cancer, patients with endometrial carcinosarcoma were excluded from most studies evaluating single-agent immunotherapy or the combination. However, the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) approved the use of pembrolizumab and lenvatinib in endometrial cancer (all histotypes) after progression on chemotherapy and single-agent immunotherapy in MSI-H cancers. In the era of precision medicine, emerging knowledge on molecular endometrial carcinosarcoma is opening new promising therapeutic options for more personalized treatment. The present review outlines state-of-the-art knowledge and future directions for patients with endometrial carcinosarcoma.

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“…Small studies comparing PreCT and ICS to primary surgery followed by adjuvant chemotherapy have shown similar outcomes. 9 , 10 These encouraging studies are often limited by small sample sizes, short follow-up, and single-institution practice patterns.…”

Section: Introductionmentioning

confidence: 99%