This study aimed to determine whether the expression of various tumor biomarkers of the mTOR pathway predicts tumor response to everolimus in metastatic recurrent endometrial cancer. Tumor blocks from 44 patients of a phase II clinical trial receiving everolimus until progression or toxicity were collected and evaluated at 3 and 6 months for response. Thirty-six blocks were available for analysis of ER, PR, HER2, LKB1, PI3K, PTEN, pAKT, 4E-BP1, p4E-BP1, and S6RP expression by immunohistochemistry, PTEN deletion by FISH, and mutational status of K-RAS, PIK3CA, PTEN, and AKT1 genes. Twelve of 34 evaluable patients had partial response or stable disease (PR, SD) and 22 had progressive disease (PD). Immunohistochemistry showed that no protein expression could predict response to everolimus. Neither could loss of PTEN expression or PTEN deletion or PTEN mutation predict patient outcome. Thirty-one samples were assessable for K-RAS mutations (ten for PR+SD and 21 for PD). There are only four patients with K-RAS mutations and none of them responded to treatment. Median progression-free survival (PFS) and overall survival (OS) were longer in patients without K-RAS mutations (PFS 3.12 ± 1.7 months versus 1.05 ± 0.4 months, p < 0.001; OS 9.28 ± 2.0 months versus 2.30 ± 1.4 months, p = 0.034). In conclusion, the level of expression of proteins of the PI3K/mTOR pathway tested in this study cannot predict response to everolimus. However, endometrial cancer patients with K-RAS mutations do not seem to derive benefit from everolimus treatment.

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Six cases of fibrosarcoma arising in previously irradiated tissues are reported, out of a total of 220 cases of fibrosarcoma treated at Mount Vernon Hospital during the last 23 years. This rare occurrence may follow at any interval from 3 to 38 years after irradiation, usually after high dosage. Four of our six cases are known to have died of the disease. The literature regarding radiation-induced fibrosarcoma is reviewed and it is suggested that adequate excision or amputation may be curative, if undertaken early enough. Images Fig. 5 Figs. 6-8 Figs. 9-11 Figs. 1-4

(Abstracted from Gynecol Oncol 2016;143:22–26) The high morbidity associated with epithelial ovarian cancer is due to its diagnosis in most patients at advanced stages (International Federation of Gynecology and Obstetrics [FIGO] stages III/IV). Women 75 to 79 years old have the highest reported incidence and mortality from epithelial ovarian cancer.