Prolonged stable disease using pazopanib in recurrent and refractory uterine leiomyosarcoma: a proposal of “pazopanib beyond progression”

Background: To date, there is no standard therapy in patients with recurrent or refractory uterine leiomyosarcoma (LMS). A case with LMS that achieved prolonged stable disease using pazopanib beyond progression (PBP) is reported. Case Report: A 49-year-old patient with recurrent and refractory LMS that achieved long-term stable disease is reported. The patient had previously received three regimens before pazopanib therapy: combination chemotherapy with ifosfamide, doxorubicin, and cisplatin (IAP), gemcitabine monotherapy, and combination therapy with bevacizumab, temozolomide, and cabozantinib. Subsequently, oral administration of pazopanib was initiated at a dose of 400 mg daily. At the third week, the dose was reduced to 200 mg daily due to grade 1 hypothyroidism. At the ninth week, a new lesion in liver was detected; however, continuation of pazopanib was selected. At the 15th week, the patient developed moderate genital bleeding and received palliative radiotherapy (30 Gy) in addition to pazopaznib. The patient occasionally developed toxicities such as hypetension and diarrhea, which were manageable. At the 59th week, her general condition was suddenly worsened due to disease progression, and pazopanib treatment was discontinued. During the period of pazopanib, recurrent tumors showed stable disease, in spite of occurrence of new lesion at liver. Subsequently, the patient died of the disease 16 months after the initiation of pazopanib monotherapy. Conclusion: PBP could be a candidate for the patients with recurrent or refractory LMS.

Uterus; Leiomyosarcoma; Pazopanib beyond progression (PBP).

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