Brian A. Van Tine, MD, PhD, associate professor in the Department of Medicine, director of the Sarcoma Program, Division of Medical Oncology at Washington University School of Medicine in St. Louis, discusses collaboration within the sarcoma field and the critical importance of clinical trials for advancing treatment. He focuses on the rare but deadly uterine leiomyosarcoma and Endometrial Stromal Sarcoma. TrialSite News does a global review of clinical trials centering on these rare sarcomas.
Sarcomas are cancers that arise from transformed cells of mesenchymal (connective tissue) origin. Connective tissue is a broad term that includes bone, cartilage, fat, vascular or hematopoietic tissues. Sarcomas can arise in any of these types of tissues. Consequently, there are many subtypes of sarcomas, which are classified based on the specific tissue and type of cells from which the tumor originates.
Sarcomas are primary connective tissue tumors, meaning they arise in connective tissue. Dr. Van Tine focuses on uterine leiomyosarcoma and endometrial stromal sarcoma. He emphasizes that physicians should collaborate because their patients overlap. Moreover, the treatment and surgical outcomes from collaboration greatly benefit patients.
Dr. Van Tine suggests patients consider clinical trials as they are a standard of care for sarcomas, and that physicians give patients the opportunity to consider all the options. He hopes someday a medical standard of care emerges for sarcomas, but that cannot happen unless there are more clinical trial results.
The uterine sarcomas form a group of malignant tumors that arises from the smooth muscle or connective tissue of the uterus. Therapy is based on staging and patient condition and utilizes one or more of the following approaches. Surgery is the mainstay of therapy if feasible involving total abdominal hysterectomy with bilateral salpingo-oophorectomy. Other approaches include radiation therapy, chemotherapy, and hormonal therapy. Prognosis is relatively poor.
Endometrial Stromal Sarcoma
Endometrial stromal sarcomas are rare malignant tumors of the uterus, and most of the information available in literature is based on small series or case reports. A proper preoperative diagnosis is difficult and in most cases the diagnosis is confirmed after hysterectomy for a presumed benign disease. Endometrial sampling, ultrasound, and magnetic resonance imaging can provide diagnostic clues. Total hysterectomy with bilateral salpingo-oopherectomy is the main line of management and for early disease complete cure is a reality. Ovarian conservation may be possible in young women with early stage disease and the role of lymphadenectomy is controversial. Adjuvant hormone therapy in the form of progesterone, gonadotropin releasing hormone analogues, and aromatase inhibitors are found to be effective in preventing recurrences. Hormone therapy, radiotherapy and surgical excision of the metastasis are recommended for recurrences.
The NIH’s National Cancer Institute lists uterine sarcoma-involved clinical trials.
A survey of Clinicaltrials.gov reports six clinical trials involving “uterine sarcoma” around the world. This includes all sponsor types (academic, industry, government, etc.) and all phases. They include the following sponsors:
- University of Utah
- Gynecologic Oncology Group/NCI
- City of Hope/NCI & American Cancer Society
- City of Hope/NCI
- Memorial Sloan Kettering Cancer Center
When we did a search for active Endometrial Stromal Sarcoma clinical trials we found four active studies including the following sponsor/sites:
- Centre Leon Berard (France)
- Frederic Amant, University Hospital Gasthuisberg (Belgium)
- Daniela Katz, Assaf-Harofeh Medical Center (Israel)
- Memorial Sloan Kettering Cancer Center/Bristol-Myers Squibb
A search for active Uterine Leiomyosarcoma clinical trials generated six (6) active studies including the following sponsor/sites:
- Gynecologic Oncology Group/NCI
- North Eastern Germany Society of Gynaecologic Oncology/Novartis & medac GmbH
- Frederic Amant, University Hospital, Gasthuisberg/Kom op tegen Kanker (Stand up to Cancer), the Flemish Cancer Society
- Gustave Roussy, Cancer Campus, Grand Paris