About Aromatase Inhibitors:
Q: Studies on Letrozole – debate on whether it is best for Stage 1,2 Ulms instead of advanced states 3, 4:
A: “ Letrozole has been best studied (though small studies) in the metastatic setting. Here is a link to a publication from the DFCI group: https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.28476
It’s really not clear how much benefit these drugs have, but anecdotally patients can benefit.”
- Matt Hemming, MD, Dana Farber Cancer Institute / LMS International Research Roundtable Workgroup Leader for LMS cell lines / PDX model
The primary literature is in metastatic disease ( stage 4) – the only trial which attempted to answer the question in early stage disease was closed due to poor accrual.
Some of the literature in the advanced setting is below.
- Suzanne George, Dana Farber Cancer Institute / LMS International Research Roundtable Member
Treatment of advanced uterine leiomyosarcoma with aromatase inhibitors.
O’Cearbhaill R, Zhou Q, Iasonos A, Soslow RA, Leitao MM, Aghajanian C, Hensley ML.Gynecol Oncol. 2010 Mar;116(3):424-9. doi: 10.1016/j.ygyno.2009.10.064. Epub 2009 Nov 24.PMID: 19932916
Phase 2 trial of aromatase inhibition with letrozole in patients with uterine leiomyosarcomas
George S, Feng Y, Manola J, Nucci MR, Butrynski JE, Morgan JA, Ramaiya N, Quek R, Penson RT, Wagner AJ, Harmon D, Demetri GD, Krasner C.Cancer. 2014 Mar 1;120(5):738-43. doi: 10.1002/cncr.28476. Epub 2013 Nov 12.Treatment of hormone positive uterine leiomyosarcoma with aromatase inhibitors.
Thanopoulou E, Thway K, Khabra K, Judson I.Clin Sarcoma Res. 2014 Jun 26;4:5. doi: 10.1186/2045-3329-4-5. eCollection 2014.PMID: 25018868
Uterine LMS Research Articles
- Characteristics of Leiomyosarcoma: Induction of Hematogenous Metastasis by Isolated Uterine Mesenchymal Tumor Stem-like Cells
- Researchers identify genes behind uterine leiomyosarcoma defined the genetic landscape of uterine leiomyosarcomas (uLMS). Furthermore, using fully point to new treatments for uterine cancer. Study results were published.
- PI3K/mTOR inhibitors may be effective against some uterine sarcomas may be effective against some uterine sarcomas hard-to-treat type of uterine sarcoma called leiomyosarcoma, and preclinical data suggest that … along with our findings that uterine leiomyosarcoma patients with activated S6 protein.
- Long-Term Outcomes after Cytoreductive Surgery and HIPEC for Morcellated Uterine Leiomyosarcoma; A Case Series
- Clinical management and outcomes of primary ovarian leiomyosarcoma – Experience from a sarcoma specialist unit
- The impact of tumor fragmentation in patients with stage I uterine leiomyosarcoma on patterns of recurrence and oncologic outcome
- Surgical and oncologic outcomes of hyperthermic intraperitoneal chemotherapy for uterine leiomyosarcoma: A systematic review of literature:
- Secondary surgical resection for patients with recurrent uterine leiomyosarcoma
- Unexpected uterine sarcomas in 4478 patients with electric power morcellation for leiomyomas
- Uterine Sarcomas: Experience from a Tertiary Cancer Care Center from India.
Recent Research Warns About Use Of Power Morcellation
A uterine leiomyosarcoma is a rare malignant (cancerous) tumor that arises from the smooth muscle lining the walls of the uterus (myometrium). There are essentially two types of muscles in the body: voluntary and involuntary. Smooth muscles are involuntary muscles; the brain has no conscious control over them. Smooth muscles react involuntarily in response to various stimuli. For example, the myometrium stretches during pregnancy to help accommodate the fetus and contracts during labor to help push out a baby during childbirth.
Uterine leiomyosarcoma is an extremely rare form of cancer, estimated to occur in 6 out of every 1,000,000 women in the United States each year. The average age at diagnosis is 51. Uterine leiomyosarcomas account for 1-2 percent of all malignant tumors of the uterus.
Symptoms of uterine leiomyosarcoma may vary from case to case depending upon the exact location, size, and progression of the tumor. Many women will not have any apparent symptoms (asymptomatic). The most common symptom is abnormal bleeding from the vagina and the uterus. Postmenopausal bleeding is an important factor that may indicate a uterine leiomyosarcoma.
Additional symptoms may occur including pressure or pain affecting the pelvis or stomach, abnormal vaginal discharge, and a change in bladder or bowel habits. General symptoms often associated with cancer include fatigue, fever, weight loss, and a general feeling of ill health (malaise).
Uterine leiomyosarcomas are malignant and may spread (metastasize) locally and to other areas of the body, especially the lungs and liver often causing life-threatening complications. Leiomyosarcomas recur in more than half of the cases sometimes within eight to 16 months of the initial diagnosis and treatment.
(Information from the National Organization of Rare Disorders/Diseases)
Leiomyosarcoma and undifferentiated sarcoma
Stages I and II