title: Pharmacological treatment for uterine leiomyosarcomas.
abstract: BACKGROUND
  Pharmacological treatment plays a major role in the management of advanced, persistent or recurrent uterine leiomyosarcoma (LMS), whereas its usefulness in the adjuvant setting is still debated. A thorough literature search was undertaken using the Pubmed databases. Systematic reviews and controlled trials on medical treatment of uterine LMS were collected and critically analyzed. Other study types were secondarily considered when pertinent.
  
  
  METHODS
  Doxorubicin (DOX), ifosfamide and dacarbazine have been long used in the treatment of this malignancy. Novel active agents are represented by gemcitabine, docetaxel, trabectedin, pazopanib and aromatase inhibitors, whereas the role of eribulin, bevacizumab, aflibercept and mammalian target of rapamycin inhibitors is still investigational.
  
  
  CONCLUSIONS
  DOX alone, gemcitabine alone, DOX + dacarbazine and gemcitabine + docetaxel may be treatment options for first-line and second-line therapies. However, the clinical benefit of the combination chemotherapy versus single-agent chemotherapy is still debated. Trabectedin is a promising agent for recurrent uterine LMS, able to obtain a prolonged disease control, with 3-month and 6-month progression-free survival rates exceeding 50 and 30%, respectively, and with sometimes unexpectedly durable responses. Pazopanib is the only approved targeted therapy. Hormone therapy with aromatase inhibitors may be a therapeutic option in heavily treated patients with slowly progressive, steroid receptor-positive tumors. Whenever possible, women with recurrent uterine LMS should be encouraged to enter well-designed clinical trials aimed to detect novel active agents.
authors.affiliation: University of Pisa, Division of Gynecology and Obstetrics, Department of Experimental and Clinical Medicine , Via Roma 56, Pisa, 56127 , Italy +39 50 992609 ; +39 50 992354 ; a.gadducci@med.unipi.it.
authors.forename: Angiolo
authors.initials: A
authors.lastname: Gadducci
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Guerrieri
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018572:Disease-Free Survival; D015507:Drugs, Investigational / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000188:drug therapy*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D014594:Uterine Neoplasms / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents; D015507:Drugs, Investigational
keywords: aromatase inhibitors; chemotherapy; docetaxel; doxorubicin; gemcitabine; mammalian target of rapamycin inhibitors; pazopanib; trabectedin; uterine leiomyosarcoma