Abstract
Background. Leiomyosarcomas (LMS) represent a heterogeneous subset of soft tissue sarcomas. Factors influencing prognosis for patients with metastatic extrauterine LMS (euLMS) are not well described. Limited data are available regarding responses to systemic therapy. Methods. We collected clinical and pathologic information for all patients with metastatic euLMS seen at Memorial Sloan Kettering Cancer Center between 1989 and 2012. Objective responses to first-line therapy were analyzed for a subset of patients with available baseline and on-treatment imaging using RECIST 1.1. Results. 215 patients with metastatic euLMS had a median overall survival (OS) of 2.6 years from the time of metastasis. Older age, male sex, and ≥3 initial sites of metastasis were associated with worse OS on multivariate analysis. Objective response rate (ORR) in N = 113 was 19% overall and 25%, 26%, and 25% for gemcitabine, gemcitabine plus docetaxel, and anthracycline-alkylator combinations. Patients whose tumors objectively responded to first-line therapy had a lower risk of death versus those who did not (Hazard Ratio 0.46; 95% CI: 0.26–0.79, p = 0.005). Conclusions. Anthracycline- and gemcitabine-based regimens have similar activity in this cohort of euLMS. Prognostic factors for OS include older age, male sex, and ≥3 initial sites.
Highlights
Leiomyosarcomas (LMS) are a heterogeneous group of smooth muscle neoplasms that can arise in the uterus, extremity, or other primary sites [1]
After institutional IRB approval, patients were identified from a database query who met the following criteria: (1) ≥1 visit at Memorial Sloan Kettering Cancer Center (MSKCC) between 1989 and 2012; (2) a pathologic diagnosis of leiomyosarcoma arising from an extrauterine primary site; and (3) developed metastatic disease at any point from diagnosis to last followup visit
Radiographic responses to first-line systemic therapy were assessed by a radiologist blinded to treatment (JL) using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, with the exception that repeat assessments to confirm response were not required in this retrospective analysis
Summary
Leiomyosarcomas (LMS) are a heterogeneous group of smooth muscle neoplasms that can arise in the uterus, extremity, or other primary sites [1]. Increasing clinical and genetic data suggest LMS arising from an extrauterine primary site represents a distinct subset of tumors [3,4,5]. A recent single-center, retrospective review of 332 patients with primary euLMS identified size and grade as distinct factors that influenced disease-specific survival [1]. About factors influencing prognosis for patients with metastatic euLMS. A series of all LMS subtypes included 101 with euLMS and found that the sole factor influencing OS was a shorter interval from diagnosis to metastatic disease [6]. Factors influencing prognosis for patients with metastatic extrauterine LMS (euLMS) are not well described. Objective responses to first-line therapy were analyzed for a subset of patients with available baseline and on-treatment imaging using RECIST 1.1. Prognostic factors for OS include older age, male sex, and ≥3 initial sites
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