Matthew P. Schlumbrecht, MD, associate professor and co-director of Cancer Prevention and Control, Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses the treatment of women with uterine leiomyosarcoma.

Eligible patients should undergo resection, says Schlumbrecht. Notably, adjuvant chemotherapy has not shown a benefit in women who undergo a complete resection.

For women with unresectable disease, single-agent doxorubicin or the combination of gemcitabine and docetaxel can be considered, says Schlumbrecht. As no data have emerged regarding the optimal sequencing of these therapies, treatment selection should be discussed with the patient.

Research efforts regarding targeted therapy in uterine leiomyosarcoma, as well as the development of clinical trials are important aspects that will help further progress in the field, concludes Schlumbrecht.

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Matthew P. Schlumbrecht, MD, discusses the treatment of women with uterine leiomyosarcoma.


Dr. Schlumbrecht on Treatment in Uterine Leiomyosarcoma

Matthew P. Schlumbrecht, MD, associate professor and co-director of Cancer Prevention and Control, Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses remaining challenges in uterine leiomyosarcoma.

Historically, uterine leiomyosarcoma has been a difficult tumor to treat, explains Schlumbrecht. Studies have not definitively shown that up front chemotherapy is effective. Additionally, a limited number of chemotherapy and targeted therapy has shown activity in the recurrent setting.

As such, the prognosis for women with this disease remains poor, says Schlumbrecht.

Going forward, identifying predictive biomarkers and underlying genetic mutations may help the field understand which patients are more likely to respond to treatment, concludes Schlumbrecht.

Matthew P. Schlumbrecht, MD, discusses remaining challenges in uterine leiomyosarcoma.

Dr. Schlumbrecht on Remaining Challenges in Uterine Leiomyosarcoma

Matthew P. Schlumbrecht, MD, associate professor and co-director of Cancer Prevention and Control, Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses the role of surgical resection in uterine leiomyosarcoma.

A prospective clinical trial comparing surgical resection with chemotherapy in uterine leiomyosarcoma would be unlikely to complete full accrual given the rarity of the disease, says Schlumbrecht.

However, retrospective data have demonstrated a potential survival advantage for patients who underwent a complete resection, particularly in those who had negative margins following surgery, says Schlumbrecht.

As such, surgical resection is advisable in eligible patients, after which chemotherapy can be considered.

Matthew P. Schlumbrecht, MD, discusses the role of surgical resection in uterine leiomyosarcoma.

Dr. Schlumbrecht on the Role of Surgical Resection in Uterine Leiomyosarcoma

Matthew P. Schlumbrecht, MD, associate professor and co-director of Cancer Prevention and Control, Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses ongoing challenges in diagnosing uterine leiomyosarcoma.

Not uncommonly, uterine leiomyosarcoma can be mistaken as a benign gynecologic condition such as fibroids, says Schlumbrecht. In many cases, women are diagnosed with uterine leiomyosarcoma after having undergone a hysterectomy for presumed fibroids, says Schlumbrecht. 

For women who are diagnosed with uterine leiomyosarcoma, data suggest that ovarian preservation may be more beneficial than performing an oophorectomy, explains Schlumbrecht.

Little progress has been made in this space, says Schlumbrecht. Understanding how the molecular landscape changes over the disease course, as well as identifying potential therapeutic targets and predictive biomarkers may spark advancement in this field.

Matthew P. Schlumbrecht, MD, discusses ongoing challenges in diagnosing uterine leiomyosarcoma.

Dr. Schlumbrecht on the Challenges of Diagnosing Uterine Leiomyosarcoma

Matthew P. Schlumbrecht, MD, associate professor and co-director of Cancer Prevention and Control, Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses investigational treatment strategies in uterine leiomyosarcoma.

The most exciting agent to enter the paradigm has been the PDGFRα antagonist olaratumab (Lartruvo), says Schlumbrecht. Prior phase II data suggested that the addition of olaratumab to single-agent doxorubicin confers a benefit in both progression-free survival and overall survival (OS). These data led to the subsequent launch of the phase III ANNOUNCE trial. However, a press release stated that the combination failed to meet the study’s primary endpoint of OS. Now, it is unknown whether olaratumab has any role in the treatment of patients with uterine leiomyosarcoma.

Aside from targeted therapies, a lot of research is focused on the potential utility of immune checkpoint inhibitors both as single agents and in combination with chemotherapy, says Schlumbrecht. To date, immune checkpoint inhibitors have shown modest activity at best. Select analyses specific to uterine leiomyosarcoma have shown response rates of 0%, he adds. As such, additional research is focused on ascertaining potential biomarkers that may help direct the field toward fruitful patient selections and combinations.

Dr. Schlumbrecht on Investigational Treatment Strategies in Uterine Leiomyosarcoma

Matthew P. Schlumbrecht, MD, associate professor and co-director of Cancer Prevention and Control, Division of Gynecologic Oncology, University of Miami Sylvester Comprehensive Cancer Center, discusses the traditional treatment approaches for patients with uterine leiomyosarcoma.

For all cancer types, Schulbrecht says, researchers are trying to understand the role of traditional approaches, such as chemotherapy, radiation, and hormone antagonism, in the current treatment paradigm. In the general landscape of sarcomas, surgical resection is a mainstay of treatment, whether it be for primary diagnosis or for oligometastatic disease. In terms of radiation, negative data from the 1980s showed no improvement in progression-free survival (PFS) or overall survival with this approach; however, pelvic radiation has been found to reduce risk of recurrence in the pelvis.

Chemotherapy, however, has played a critical role in the management of this disease since the 1960s, Schlumbrecht says, both in the form of a single agent and used in combination with other drugs. The advent of targeted therapies has also opened the door to several new options for patients. Pazopanib (Votrient) and trabectedin (Yondelis) have shown modest activity in clinical trials, but the aggressive nature of the tumor limits PFS benefit to 3 or 4 months.

Matthew P. Schlumbrecht, MD

Articles

Dr. Schlumbrecht on Treatment in Uterine Leiomyosarcoma

Dr. Schlumbrecht on Remaining Challenges in Uterine Leiomyosarcoma

Dr. Schlumbrecht on the Role of Surgical Resection in Uterine Leiomyosarcoma

Dr. Schlumbrecht on the Challenges of Diagnosing Uterine Leiomyosarcoma

Dr. Schlumbrecht on Investigational Treatment Strategies in Uterine Leiomyosarcoma

Dr. Schlumbrecht on Traditional Treatment Approaches for Uterine Leiomyosarcoma