307P - Hormonal therapy vs combination chemotherapy in metastatic leiomyosarcomas: A systematic review

Background

Uterine leiomyosarcoma (uLMS) is a rare, aggressive subtype of uterine cancer. Metastatic uLMS is known for its poor prognosis. uLMS have recurrence rates of 50-70%, with an overall 5-year survival less than 15% in advanced stages. The main treatment for localized uLMS is surgery. For unresectable or advanced uLMS, other options such as chemotherapy and hormonal therapy can be offered.

Methods

We conducted a search across 5 databases, Google Scholar, Science Direct, PubMed, EMBASE & Scopus for studies within the last 15 years. We included studies that recorded combination chemotherapy/hormonal therapy as the treatment regime for histologically confirmed metastatic/unresectable uLMS. We excluded studies with <5 samples, those that included other uterine cancers & non-English articles. Quality of the studies were assessed by the Newcastle-Ottawa Scale (NOS).

Results

We found 10 studies, with a total of 427 metastatic uLMS patients. Combination chemotherapy had much higher rates of response & progression-free survival compared to hormonal therapy. Gemcitabin-docetaxel was the most common regime, with high effectivity. Addition of targeted therapy did not improve outcomes significantly. However, combination chemotherapy had a much higher proportion of grade 3-4 toxicity. Most common side effects were myelosuppression, fatigue & liver toxicity, resulting in much higher rates of therapy discontinuation due to the side effects. Hormonal therapy was much more tolerable, with common side effects including hot flashes, weight gain, muscle pain & joint pain. Unfortunately, hormonal therapy had higher proportions of therapy discontinuation due to disease progression, and had lower response rates, shorter overall survival & progression-free survival. Overall, patient-specific factors play a crucial role in treatment decisions. Hormonal therapy has a more attractive side effect profile, while combination chemotherapy though more aggressive may be favorable in cases requiring rapid tumor control.

Conclusions

uLMS is an aggressive cancer with hormonal therapy & combination chemotherapy as treatment options. Hormonal therapy has a better side effect profile, with chemotherapy having better effectivity and survival rates.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

P. Angel.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.