Adjuvant Chemo Should Be Used in Gynecologic Carcinosarcoma

Liam Davenport

January 20, 2022

Gynecologic carcinosarcomas are rare, accounting for only about 5% of all uterine cancers and 1% to 3% of ovarian cancers, and so there is little clinical data on their management.

A new contribution to the literature is made by French researchers reporting registry data, which suggest patients with patients with these rare tumors should undergo adjuvant chemotherapy after surgery regardless of disease stage, as this improves the generally poor prognosis.

Their research, involving more than 420 women with gynecologic carcinosarcomas diagnosed over 7 years, suggests that adjuvant chemotherapy has "positive impact" on survival "in all stages," including early disease.

The anaylsis, headed by Clémence Romeo, MD, Medical Oncology Department, Centre Léon Bérard, Lyon, France, was published in Cancers on January 12.

Approached for comment, Maurie Markman, MD, an expert in gynecologic cancers, said the study is "a very important example of where we need to be going in terms of evidence that is going to direct our care, particularly in relatively uncommon tumors."

Markamn, who is president of medicine and science at the Cancer Treatment Centers of America, Philadelphia, Pennsylvania, told Medscape Medical News that "the idea we can do a phase 3 randomized trial to answer questions about the management of carcinosarcomas has been absurd concept for decades."

Consequently, "we absolutely need more of this type of an effort."

However, given that there are limitations to this kind of research, he noted, relating to the construction of the database, the questions it asks are, how is the disease defined, and how well are the findings audited?

Previous research into gynecologic carcinosarcomas suggests that it is "not surprising that there may be benefit from adjuvant therapies."

This new registry analysis confirms "what smaller studies...from individual institutions" have shown.

Details of Results From "Real-Life" Analysis

For their study, the authors turned to the French national, prospective Rare Malignant Gynecological Tumors (TMRG) network to assess patient outcomes in a "real-life setting."

They collected data on all 425 gynecologic carcinosarcomas, including 313 uterine and 112 ovarian tumors, diagnosed between 2011 and 2018 at 12 participating centers.

The median age at diagnosis was 69 years. The majority (83.0%) of ovarian carcinosarcoma patients had stage ≥III disease, while 45.4% of those with uterine tumors had stage III/IV disease.

Surgery was performed in 90.3% of patients, and 63.3% received adjuvant chemotherapy, at a median of six cycles. Adjuvant radiotherapy was performed in 66.1% of patients, with 76.2% given subsequent brachytherapy.

After a median follow-up of 47.4 months, median PFS was 15.1 months for ovarian carcinosarcoma and 14.8 months for uterine disease. Median overall survival was 37.1 months and 30.6 months, respectively.

Among uterine carcinosarcoma patients who received adjuvant chemotherapy followed by radiotherapy, the median PFS was 41.0 months for those with early-stage disease and 18.9 months in advanced disease.

Multivariate analysis indicated that disease stage was significantly associated with PFS (P = .0024 for trend), as was initial radiotherapy (P < .0001).

In ovarian carcinosarcoma, surgery (P < .0001) and initial chemotherapy (P = .0103) were significantly associated with better PFS.

Combination Therapy on Relapse

Recurrence or disease progression occurred in 64.1% of patients, at a median of 5.2 months after the end of chemotherapy. Combination chemotherapy was given to 61.1% of these patients, while 38.9% received monotherapy.

Combination chemotherapy was associated with a median PFS of 6.7 months, vs 2.2 months for monotherapy.

"Although [patients] are most often elderly and comorbid," the team writes, "these results encourage us not to de-escalate the doublet to a monotherapy."

They add that carboplatin/paclitaxel combination chemotherapy "was the most effective systemic therapy, even in pre-treated patients, and should be used for all patients."

Following a second relapse or progression, the median PFS with subsequent therapy was 4.4 months in patients with ovarian tumors and 2.4 months in uterine carcinosarcomas.

No funding was declared. No relevant financial relationships have been reported.

Cancers. Published January 12, 2022. Abstract

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