Hormonal therapy in uterine sarcomas

Abstract

Uterine sarcomas (USs) are a group of rare but aggressive uterine malignancies, accounting for only 1% of the malignant tumors of female reproductive organs. Due to the high rate of recurrence and metastasis, the prognosis of USs is poor. Given the high mortality rate and limited clinical benefit of surgery and adjuvant chemoradiotherapy, hormonal therapy has shown good prospects in recent years. Hormonal agents include progestins, aromatase inhibitors (AIs), and gonadotropin‐releasing hormone analogue (GnRH‐a). According to the literature, hormonal therapy has been confirmed effective for recurrent, metastatic or unresectable low‐grade endometrial stromal sarcoma (LGESS) and hormone receptor positive (ER+/PR+) uterine leiomyosarcoma (uLMS) with favorable tolerance and compliance. Besides, hormonal therapy can also be used in patients with early‐staged disease who desire to preserve fertility. However, due to the rarity of USs, the rationale of hormonal therapy is generally extrapolated from data of hormone‐sensitive breast cancer, and present studies of hormonal therapy in USs were almost limited to case reports and small‐sized retrospective studies. Therefore, further systematic researches and standardized clinical trials are needed to establish the optimal hormonal therapy regimen of USs. Herein, we reviewed the existing studies related to the hormonal therapy in USs in order to provide reference for clinical management in specific settings.

Tumor Immunology and Tumor Evolution: Intertwined Histories

“…In doing so, Beatson leveraged on the connection between sex steroid hormones and cancer (Beatson, 1896), thereby paving to way to hormonal therapy in hormone-sensitive cancers (such as breast, ovarian, endometrial, and prostate cancers). This treatment modality became later a widely deployed strategy, still in use today (Shevach et al, 2019;Zang et al, 2019). Nonetheless, the underlying link between hormones, inflammation, and cancer began to unravel only more recently (Gharwan et al, 2015;Key, 1995;Mantovani et al, 2008;Ö zdemir and Dotto, 2019).…”

Metastatic low‐grade endometrial stromal sarcoma after 24 years: A case report and review of recent molecular genetics

“…Xu et al reported 36 cases with good outcome after lobectomy in the majority of the cases 12 . Hormonal treatment is recommended given the established sensitivity of LGESS to these agents 12,37 . Our patient was treated with Anastrozole which to this day has stabilized her disease.…”

Primary vulvar leiomyosarcoma localized in the Bartholin's gland area: A case report and review

“…Yamaguchi et al suggested that Letrozole as well as progestins could be the first choice for patients with recurrent or residual low-grade endometrial stromal sarcoma (51). It seems that letrozole is the first-line hormone drug for postoperative adjuvant therapy in patients with stage I uterine leiomyosarcoma, while exemestane and anastrozole are for second-line treatment in patients with recurrent, metastatic and unresectable uterine leiomyosarcoma (52). In a clinical trial by George et al (53) of 27 postmenopausal women with metastatic and/or unresectable uterine leiomyosarcoma with positive estrogen receptors and/or postive progesteron receptors it has been found that the rate of stable disease was 54% in all patients and the 12-week rate of progression free survival 50%.…”