Successful Use of Dydrogesterone as Maintenance Therapy in Recurrent Endometrial Stromal Sarcoma: A Case Report

Abstract

Endometrial stromal sarcoma is known to be a hormone-dependent tumor. Efficacy of hormonal therapy including high-dose progestins, aromatase inhibitors or gonadotropin-releasing hormone analogs has been reported. We report a case of recurrent endometrial stromal sarcoma, the tumor cells of which were strongly positive for CD10, estrogen and progesterone receptors. Although almost all of the pelvic tumors infiltrating the rectum or pelvic side wall remained, the patient is alive with slight disease 9 years and 6 months after the initial failure. During the treatment period of 4 years and 3 months, the patient was treated exclusively with dydrogesterone at a daily dose of 10 mg and the tumor clinically disappeared. Dydrogesterone at a daily dose of 10 mg may be effective in treating low-grade endometrial stromal sarcoma.

Progesterone and estrogen receptor expression by canine cutaneous soft tissue sarcomas

“…Also, the response to hormonal treatment (eg. selective ER or PR modulators, aromatase inhibitors) has also been described for several types of human STS (Ioffe et al 2009, Byer et al 2011, Meijer et al 2011, Akashi et al 2013, Li et al 2013, Thanopoulou et al 2014, which may prove to be useful in dogs with the evolution of the pathogenesis understanding.…”

“…For prognostic purposes and in search of new treatment targets, recent studies in human medicine have evaluated the expression of estrogen receptors (ER) and progesterone receptors (PR) in STS (Ioffe et al 2009, Valkov et al 2011, Akashi et al 2013, Li et al 2013, Sorbye et al 2013, Thanopoulou et al 2014. In dogs, the prognosis related to ER and PR expression was evaluated mainly in mammary neoplasms (Millanta et al 2005, Millanta et al 2006.…”

Potential alternative progestin therapy for low-grade endometrial stromal sarcoma: A case report

“…No report has described the therapeutic effects of DNG against gynecologic stromal malignancies, excluding the outcomes in one patient with uterine adenosarcoma ( Tasaka et al, 2013 ). In contrast, a case report described the use of the progestin dydrogesterone in a patient with LG-ESS that relapsed after chemotherapy; the drug was linked to tumor shrinkage and disappearance over the course of 4 years ( Akashi et al, 2013 ).…”

Long-term survival of patients with recurrent endometrial stromal sarcoma: a multicenter, observational study

“…Therefore, dydrogesterone is preferable to other progestins such as MPA because of the lack of adverse effects of long-term medication or repeated courses of treatment [ 36 ]. One patient in the present study (Case 4) experienced troublesome adverse effects of a GnRH agonist; subsequent use of dydrogesterone was effective [ 37 ].…”