Uterine leiomyosarcoma well-controlled with eribulin mesylate

Abstract

Uterine leiomyosarcoma is a rare type of malignant gynecological tumor and has a poor prognosis; therefore, this tumor is often difficult to treat. Some new drugs have been approved during the past several years in Japan and are expected to be efficacious. Eribulin, one of these drugs, is a natural product of halichondrin B, which is isolated from a marine sponge. A recent clinical trial comparing eribulin with dacarbazine to target liposarcoma and leiomyosarcoma indicated that overall survival (OS) was prolonged by treatment with eribulin. We report a case of uterine progressive leiomyosarcoma that responded to eribulin. A 57-year-old woman was suspected of having leiomyosarcoma based on an endometrial biopsy and imaging examinations. Although the tumor grew toward the uterine artery on the right side of the uterine cervix, we performed a total abdominal hysterectomy and bilateral salpingo-oophorectomy to obtain an outcome of no gross residual disease. However, the margin of the right side of the uterine cervix was histologically positive, so leiomyosarcoma stage IIB (pT2bcN0cM0, FIGO2008) was diagnosed. Gemcitabine and docetaxel therapy was administered postoperatively. However, after three cycles, the residual tumor progressed. Other anticancer drugs were administered but were ineffective. We administered eribulin (1.4 mg/m 2) as a fourth-line regimen, and the mass decreased by 32% after four cycles. However, the residual tumor continued to grow after eight cycles. The only adverse event associated with eribulin treatment was mild, grade 2 neutropenia. For our patient, eribulin was effective for her recurrent leiomyosarcoma. In selecting chemotherapy, there are currently no fixed guidelines; we should consider the characteristics and adverse events associated with each drug and patient performance status and comorbidities. In this patient, eribulin was associated with few adverse events, an easy route of administration and a good quality of life. Therefore, eribulin is expected to be efficacious for the treatment of gynecologic sarcoma.

Achievement of a durable response with eribulin for relapsed cardiac metastasis of uterine leiomyosarcoma after surgery: a case report and literature review

“…Of note, eribulin can be administered to patients with all subtypes of soft tissue sarcomas in Japan. Recently, two case reports described that treatment with eribulin as fourth-line therapy resulted in good responses in patients with refractory U-LMS, whose PFS was approximately 6-9 months (17,18). Surprisingly, in our patient, the reduction in tumor volume induced by eribulin was sustained for 17 months and improved her general condition without the development of severe adverse events (Figure 3).…”

The systemic treatment of uterine leiomyosarcomas

“…[ 79 – 84 ] Eribulin in uLMS was studied in 3 reports. [ 85 – 87 ] Bevacizumab was reported in 3 references. [ 88 – 90 ] Interestingly, immunotherapy for uLMS was discussed in only 1 report.…”

A bibliometric analysis of literatures on uterine leiomyosarcoma in the last 20 years

“…A few novel uLMS treatment approaches were also mentioned in recent case reports. These included the use of eribulin mesylate to manage uLMS cases ( 82 ) and high-intensity focused ultrasound to treat recurrent uLMS ( 83 ). The author considers that the gradual pattern in uLMS case reports over the previous 20 years could be related to both the difficulties in identifying and treating uLMS and technological improvements.…”