title: Management Strategies in Advanced Uterine Leiomyosarcoma: Focus on Trabectedin.
abstract: The treatment of advanced uterine leiomyosarcomas (U-LMS) represents a considerable challenge. Radiological diagnosis prior to hysterectomy is difficult, with the diagnosis frequently made postoperatively. Whilst a total abdominal hysterectomy is the cornerstone of management of early disease, the role of routine adjuvant pelvic radiotherapy and adjuvant chemotherapy is less clear, since they may improve local tumor control in high risk patients but are not associated with an overall survival benefit. For recurrent or disseminated U-LMS, cytotoxic chemotherapy remains the mainstay of treatment. There have been few active chemotherapy drugs approved for advanced disease, although newer drugs such as trabectedin with its pleiotropic mechanism of actions represent an important addition to the standard front-line systemic therapy with doxorubicin and ifosfamide. In this review, we outline the therapeutic potential and in particular the emerging evidence-based strategy of therapy with trabectedin in patients with advanced U-LMS.
authors.affiliation: Department of Obstetrics and Gynecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Amant
authors.affiliation: Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Via Venezian 1, 20133 Milan, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Lorusso
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany.
authors.forename: Alexander
authors.identifier: 0000-0002-3002-6039
authors.initials: A
authors.lastname: Mustea
authors.affiliation: Department of Medical Oncology, La Timone University Hospital, 264 rue Saint Pierre, 13385 Marseille, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Duffaud
authors.affiliation: Département de Medecine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, 94805 Villejuif Cedex, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Pautier