Article Data

  • Views 745
  • Dowloads 135

Original Research

Open Access

Efficacy and safety of carboplatin plus paclitaxel in gynecological carcinosarcoma: a Brazilian retrospective study

  • Jessé L. da Silva1,2,*,
  • Lucas Z. de Albuquerque3
  • Ana L. Gasparotto4
  • Beatriz R. L.de Aguiar5
  • Darlyane de S.B. Rodrigues6
  • Ticiane C. Farias7
  • Ticiane C. Farias2
  • Andreia C. de Melo11

1Clinical Research Division, Brazilian National Cancer Institute, 20231050 Rio de Janeiro, Brazil

2Department of Clinical Oncology, Brazilian National Cancer Institute, 20220410 Rio de Janeiro, Brazil

3Faculty of Medicine, Federal Fluminense University, 24033900 Niteroi, Brazil

4Faculty of Medicine, Federal University of Parana, 80060240 Curitiba, Brazil

5Department of Nursing, University of Brasilia, 70910900 Brasília, Brazil

6Department of Speech Therapy, Federal University of Paraíba, 58051900 Joao Pessoa, Brazil

7Center of Teacher Training, Federal University of Campina Grande, 58900000 Campina Grande, Brazil

DOI: 10.31083/j.ejgo.2021.03.2355 Vol.42,Issue 3,June 2021 pp.512-520

Submitted: 18 December 2020 Accepted: 03 February 2021

Published: 15 June 2021

*Corresponding Author(s): Jessé L. da Silva E-mail: jesse.silva@inca.gov.br

Abstract

Objective: To evaluate the efficacy and toxicity profile of carboplatin and paclitaxel (CP) in women with gynecological carcinosarcoma. Methods: This is a single-center retrospective study that included 64 women with stage I–IV gynecological carcinosarcoma treated with CP between January 2012 and December 2017. Patient demographics, tumor characteristics, toxicity, and survival outcomes, such as clinical benefit rate (CBR), progression-free survival (PFS) and overall survival (OS) were evaluated. Results: The median age was 65.2 years. Most patients were stage III–IV (73.5%) and had undergone surgery as initial treatment (95.3%). Optimal cytoreduction (R0) was associated with better median PFS (P = 0.011) and OS (P = 0.019) as compared to suboptimal cytoreduction (R1/R2). The CBR after first-line palliative CP was 36.7% (6.7% of complete response, 3.3% of partial response, and 26.7% of stable disease). For the general population, the median PFS was 11 months (95% confidence interval, CI: 8–50), and the median OS was 26 months (95% CI: 12-not reached, NR). The most common adverse event was anemia observed in 71.8% of patients. Conclusion: This study suggests that CP may be an effective and safe option with a more convenient schedule for treating gynecological carcinosarcoma.

Keywords

Gynecological carcinosarcoma; Uterine malignant mixed Mullerian tumor; Carboplatin; Paclitaxel; Chemotherapy

Cite and Share

Jessé L. da Silva,Lucas Z. de Albuquerque,Ana L. Gasparotto,Beatriz R. L.de Aguiar,Darlyane de S.B. Rodrigues,Ticiane C. Farias,Ticiane C. Farias,Andreia C. de Melo1. Efficacy and safety of carboplatin plus paclitaxel in gynecological carcinosarcoma: a Brazilian retrospective study. European Journal of Gynaecological Oncology. 2021. 42(3);512-520.

References

[1] Zhao S, Bellone S, Lopez S, Thakral D, Schwab C, English DP, et al. Mutational landscape of uterine and ovarian carcinosarcomas implicates histone genes in epithelial-mesenchymal transition. Proceedings of the National Academy of Sciences of the United States of America. 2016; 113: 12238–12243.

[2] Jin Z, Ogata S, Tamura G, Katayama Y, Fukase M, Yajima M, et al. Carcinosarcomas (malignant mullerian mixed tumors) of the uterus and ovary: a genetic study with special reference to histogenesis. International Journal of Gynecological Pathology. 2003; 22: 368–373.

[3] Banik T, Halder D, Gupta N, Dey P. Malignant mixed Müllerian tumor of the uterus: diagnosis of a case by fine-needle aspiration cytology and review of literature. Diagnostic Cytopathology. 2012; 40: 653–657.

[4] El-Nashar SA, Mariani A. Uterine carcinosarcoma. Clinical Obstetrics and Gynecology. 2011; 54: 292–304.

[5] Gadducci A, Cosio S, Romanini A, Genazzani AR. The management of patients with uterine sarcoma: a debated clinical challenge. Critical Reviews in Oncology/Hematology. 2008; 65: 129– 142.

[6] Sutton G, Kauderer J, Carson LF, Lentz SS, Whitney CW, Gallion H, et al. Adjuvant ifosfamide and cisplatin in patients with completely resected stage I or II carcinosarcomas (mixed mesodermal tumors) of the uterus: a Gynecologic Oncology Group study. Gynecologic Oncology. 2005; 96: 630–634.

[7] Sherman ME, Devesa SS. Analysis of racial differences in incidence, survival, and mortality for malignant tumors of the uterine corpus. Cancer. 2003; 98: 176–186.

[8] Bansal N, Herzog TJ, Seshan VE, Schiff PB, Burke WM, Cohen CJ, et al. Uterine carcinosarcomas and grade 3 endometrioid cancers: evidence for distinct tumor behavior. Obstetrics and Gynecology. 2008; 112: 64–70.

[9] Garg G, Shah JP, Kumar S, Bryant CS, Munkarah A, Morris RT. Ovarian and uterine carcinosarcomas: a comparative analysis of prognostic variables and survival outcomes. International Journal of Gynecologic Cancer. 2010; 20: 888–894.

[10] Nemani D, Mitra N, Guo M, Lin L. Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecologic Oncology. 2008; 111: 82–88.

[11] Fader AN, Java J, Tenney M, Ricci S, Gunderson CC, Temkin SM, et al. Impact of histology and surgical approach on survival among women with early-stage, high-grade uterine cancer: an NRG On- cology/Gynecologic Oncology Group ancillary analysis. Gynecologic Oncology. 2016; 143: 460–465.

[12] Tanner EJ, Leitao MM, Garg K, Chi DS, Sonoda Y, Gardner GJ, et al. The role of cytoreductive surgery for newly diagnosed advanced-stage uterine carcinosarcoma. Gynecologic Oncology. 2011; 123: 548–552.

[13] Wolfson AH, Brady MF, Rocereto T, Mannel RS, Lee Y, Futoran RJ, et al. A gynecologic oncology group randomized phase III trial of whole abdominal irradiation (WAI) vs. cisplatin-ifosfamide and mesna (CIM) as post-surgical therapy in stage I-IV carcinosar- coma (CS) of the uterus. Gynecologic Oncology. 2007; 107: 177– 185.

[14] Galaal K, Godfrey K, Naik R, Kucukmetin A, Bryant A. Adju- vant radiotherapy and/or chemotherapy after surgery for uterine carcinosarcoma. Cochrane Database of Systematic Reviews. 2011; CD006812.

[15] National Comprehensive Cancer Network. NCCN Clinical Prac- tice Guidelines in Oncology: endometrial carcinoma. Version 3. 2012. Available at: http://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf (Accessed: 8 July 2019).

[16] Powell MA, Filiaci VL, Hensley ML, Huang HQ, Moore KN, Tewari KS, et al. A randomized phase 3 trial of paclitaxel

(P) plus carboplatin (C) versus paclitaxel plus ifosfamide (I) in chemotherapy-naive patients with stage I-IV, persistent or recurrent carcinosarcoma of the uterus or ovary: an NRG Oncology trial. Journal of Clinical Oncology. 2019; 37: 5500.

[17] Powell MA, Filiaci VL, Rose PG, Mannel RS, Hanjani P, Degeest K, et al. Phase II evaluation of paclitaxel and carboplatin in the treatment of carcinosarcoma of the uterus: a Gynecologic Oncology Group study. Journal of Clinical Oncology. 2010; 28: 2727– 2731.

[18] Lacour RA, Euscher E, Atkinson EN, Sun CC, Ramirez PT, Coleman RL, et al. A phase II trial of paclitaxel and carboplatin in women with advanced or recurrent uterine carcinosarcoma. International Journal of Gynecological Cancer. 2011; 21: 517–522.

[19] Schwartz LH, Litière S, de Vries E, Ford R, Gwyther S, Mandrekar S, et al. RECIST 1.1-update and clarification: from the RECIST committee. European Journal of Cancer. 2016; 62: 132–137.

[20] Common Terminology Criteria for Adverse Events (CTCAE). 2017. Available at: https://ctep.cancer.gov/protocoldevelopmen t/electronic_applications/docs/ctcae_v5_quick_reference_5x7.pd f (Accessed: 25 November 2020).

[21] Vrieze SI. Model selection and psychological theory: a discussion of the differences between the Akaike information criterion (AIC) and the Bayesian information criterion (BIC). Psychological Methods. 2012; 17: 228–243.

[22] R Core Team. R: a language and environment for statistical com- puting. R Foundation for Statistical Computing, Vienna, Austria. 2014. Available at: http://www.R-project.org/ (Accessed: 25 November 2020).

[23] Lucic N, Draganovic D, Sibincic S, Ecim-Zlojutro V, Milicevic S. Myometrium invasion, tumour size and lymphovascular invasion as a prognostic factor in dissemination of pelvic lymphatics at endometrial carcinoma. Medical Archives. 2017; 71: 325–329.

[24] Matsuo K, Takazawa Y, Ross MS, Elishaev E, Podzielinski I, Yunokawa M, et al. Significance of histologic pattern of carcinoma and sarcoma components on survival outcomes of uterine carcinosarcoma. Annals of Oncology. 2016; 27: 1257–1266.

[25] Matsuo K, Takazawa Y, Ross MS, Elishaev E, Yunokawa M, Sheridan TB, et al. Characterizing sarcoma dominance pattern in uterine carcinosarcoma: homologous versus heterologous element. Surgical Oncology. 2018; 27: 433–440.

[26] Callister M, Ramondetta LM, Jhingran A, Burke TW, Eifel PJ. Malignant mixed Müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome. International Journal of Radiation Oncology, Biology, Physics. 2004; 58: 786–796.

[27] Reed NS, Mangioni C, Malmström H, Scarfone G, Poveda A, Pecorelli S, et al. Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study (protocol 55874). European Journal of Cancer. 2008; 44: 808–818.

[28] Einstein MH, Klobocista M, Hou JY, Lee S, Mutyala S, Mehta K, et al. Phase II trial of adjuvant pelvic radiation “sandwiched” between ifosfamide or ifosfamide plus cisplatin in women with uterine carcinosarcoma. Gynecologic Oncology. 2012; 124: 26–30.

[29] Makker V, Abu-Rustum NR, Alektiar KM, Aghajanian CA, Zhou Q, Iasonos A, et al. A retrospective assessment of outcomes of chemotherapy-based versus radiation-only adjuvant treatment for completely resected stage I-IV uterine carcinosarcoma. Gynecologic Oncology. 2008; 111: 249–254.

[30] Sutton G, Brunetto VL, Kilgore L, Soper JT, McGehee R, Olt G, et al. A phase III trial of ifosfamide with or without cisplatin in carcinosarcoma of the uterus: a Gynecologic Oncology Group Study. Gynecologic Oncology. 2000; 79: 147–153.

[31] Homesley HD, Filiaci V, Markman M, Bitterman P, Eaton L, Kilgore LC, et al. Phase III trial of Ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: a Gynecologic Oncology Group Study. Journal of Clinical Oncology. 2007; 25: 526– 531.

[32] Kietpeerakool C, Suprasert P, Srisomboon J. Adverse affects of pa- clitaxel and carboplatin combination chemotherapy in epithelial gynecologic cancer. Journal of the Medical Association of Thailand. 2005; 88: 301–306.

[33] de Jong RA, Nijman HW, Wijbrandi TF, Reyners AK, Boezen HM, Hollema H. Molecular markers and clinical behavior of uterine carcinosarcomas: focus on the epithelial tumor component. Modern Pathology. 2012; 24: 1368–1379.

[34] Leskela S, Pérez-Mies B, Rosa-Rosa JM, Cristobal E, Biscuola M, Palacios-Berraquero ML, et al. Molecular basis of tumor heterogeneity in endometrial carcinosarcoma. Cancers. 2020; 11: 964.

[35] Han C, Altwerger G, Menderes G, Haines K, Feinberg J, Lopez S, et al. Novel targeted therapies in ovarian and uterine carcinosarcomas. Discovery Medicine. 2018; 25: 309–319.

[36] Peng W, Jiang R, WU X, Li Z, Sun M, Yu B, et al. PDL1, PDL2, and CD8+ TIL expression in ovarian carcinosarcoma. Journal of Clinical Oncology. 2015; 33: e16595.

[37] Pinto A, Mackrides N, Nadji M. PD-L1 Expression in carcinosarcomas of the gynecologic tract: a potentially actionable biomarker. Applied Immunohistochemistry & Molecular Morphology. 2018; 26: 393–397.

[38] Rottmann D, Snir OL, Wu X, Wong S, Hui P, Santin AD, et al. HER2 testing of gynecologic carcinosarcomas: tumor stratification for potential targeted therapy. Modern Pathology. 2020; 33: 118–127.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time

Conferences

Top