Adjuvant chemotherapy in patients with uterine carcinosarcoma: a review of clinical outcomes and considerations

ABSTRACT

Introduction

Uterine carcinosarcoma (UCS) is a highly aggressive disease, and had been traditionally recognized as a uterine sarcoma. In recent years, it has been categorized as a subtype of high-grade endometrial cancer. Its prognosis is extremely poor, and approximately half of the patients with early-stage disease will recure and eventually die. Due to its high relapse rate, an effective adjuvant therapy is needed. As UCS has a high incidence of distant recurrence, systemic chemotherapy may be beneficial as an adjuvant therapy even in completely resected early-stage cases. A search of PubMed database was performed for research articles published between January 1981 and January 2022.

Areas covered

We have summarized the current evidence of adjuvant chemotherapy in patients with UCS.

Expert opinion

There have been only a limited number of prospective randomized trials which enrolled solely carcinosarcoma, particularly with only adjuvant chemotherapy. Several trials have suggested that adjuvant chemotherapy is effective for both early and advance stage. Regarding the chemotherapy regimens, combination chemotherapies including either platinum or ifosfamide are all effective as an adjuvant chemotherapy. Among these, currently paclitaxel plus carboplatin is considered the most preferred regimen in terms of efficacy and toxicity profile.

KEYWORDS:

• Uterine neoplasms
• carcinosarcoma
• adjuvant chemotherapy
• survival

Article highlights

• Uterine carcinosarcoma (UCS) is a highly aggressive disease, which has been categorized as a subtype of high-grade endometrial cancer.

• Prognosis of UCS is extremely poor because of high relapse rate including distant recurrence.

• Systemic chemotherapy may be beneficial as an adjuvant therapy even in completely resected early-stage UCS cases.

• It seems that the two-drug combinations ifosfamide plus paclitaxel (IT), ifosfamide plus cisplatin (IP), and paclitaxel plus carboplatin (TC) were all effective as adjuvant chemotherapy, with TC preferred over both IT and IP due to a lower toxicity profile associated with TC therapy.

• The new targeted drugs may be evaluated in the adjuvant setting in endometrial cancer including UCS in the near future.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.