Metastatic uterine sarcoma: A systematic review of the literature

Abstract

5105 Background: Uterine sarcomas are rare and management of metastatic disease often conforms to treatment practice for other metastatic soft tissue sarcomas. We have conducted a systematic review of systemic chemotherapy in the management of metastatic uterine sarcoma. Methods: MEDLINE and the Cochrane Library databases, as well as the proceedings from ASCO, were searched for articles that were (1) systematic reviews, practice guidelines, meta-analysis, or randomized controlled trials (RCT) comparing treatment regimens for metastatic uterine sarcoma or (2) prospective phase II trials or retrospective reviews reporting the effects of treatment for > 20 patients. Efficacy (response rate, progression free and overall survival) and toxicity were evaluated. Results: Three RCTs and 21 prospective phase II trials were identified that met the search criteria. The overall response rate (RR) for single agent doxorubicin (D) was 19% for all sub-types of metastatic uterine sarcomas. D combined with either dimethyl triazenoimidazole carboxamide (DTIC) or cyclophosphamide compared to D alone showed no survival benefit and there was increased toxicity with combination treatment. The two most active single agents for first-line treatment of mixed mesodermal tumours (MMT) were ifosfamide (I) (RR=39% and cisplatinum (C) (RR=19%). In an RCT of first-line treatment of MMT, the combination of I and C compared to I alone, resulted in a higher RR (57% versus 39%) and a small improvement in progression-free survival (6.0 vs 4.0 months, p=0.02). However, there was also greater toxicity and no significant improvement in overall survival. A small phase II study of second-line therapy in patients with leiomyosarcoma (LMS) treated with the combination of gemcitabine and docetaxel reported a RR of 53% and a relatively mild toxicity profile. Pooled efficacy and toxicity data will be presented. Conclusions: There is a paucity of high quality RCTs that examine the role of systemic therapy in patients with metastatic uterine sarcoma. Patients and practitioners should be encouraged to take part in such trials. No significant financial relationships to disclose.