title: An uncommon response to metronomic therapy in a heavily pretreated patient with metastatic carcinosarcoma: a case report.
abstract: BACKGROUND
  Uterine carcinosarcoma is well known for its aggressive behavior. There is little evidence regarding the gold standard combination chemotherapy in metastatic or locally advanced carcinosarcoma, due to poor survival outcomes obtained with conventional scheduled chemotherapy. This case report represents the first-ever reported objective response to a metronomic chemotherapy regimen and adds to the current literature.
  
  
  METHODS
  We describe a case of a Caucasian woman diagnosed with metastatic carcinosarcoma that had already been treated with multiple lines of conventional chemotherapy, with progressive disease. This patient had a surprising clinical and imaging response when treated with oral metronomic cyclophosphamide.
  
  
  CONCLUSIONS
  We reviewed the mechanism of action implicated in metronomic chemotherapy, and correlated it with the biology of disease in carcinosarcoma. This information may add to the current literature, providing important insights to future clinical trials in this patient population.
authors.affiliation: Hospital Sírio Libanês, São Paulo, SP, Brazil. dgagliato@gmail.com.
authors.forename: Debora de Melo
authors.identifier: http://orcid.org/0000-0001-7480-0674
authors.initials: Dde M
authors.lastname: Gagliato
authors.affiliation: Hospital Sírio Libanês, São Paulo, SP, Brazil.
authors.forename: Rudinei Diogo Marques
authors.initials: RD
authors.lastname: Linck
authors.affiliation: Hospital Sírio Libanês, São Paulo, SP, Brazil.
authors.forename: Regis Otaviano Franca
authors.initials: RO
authors.lastname: Bezerra
authors.affiliation: Hospital Sírio Libanês, São Paulo, SP, Brazil.
authors.forename: Mirela
authors.initials: M
authors.lastname: Souto
authors.affiliation: Hospital Sírio Libanês, São Paulo, SP, Brazil.
authors.forename: Gabriel Lima
authors.initials: GL
authors.lastname: Lopes
authors.affiliation: A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
authors.forename: Glauco
authors.initials: G
authors.lastname: Baiocchi
authors.affiliation: Hospital Sírio Libanês, São Paulo, SP, Brazil.
authors.forename: Max Senna
authors.initials: MS
authors.lastname: Mano
mesh_terms: D059250:Administration, Metronomic; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage* / Q000633:toxicity; D000971:Antineoplastic Combined Chemotherapy Protocols; D002296:Carcinosarcoma / Q000188:drug therapy* / Q000473:pathology; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000633:toxicity; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000556:secondary; D018203:Sarcoma, Endometrial Stromal / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000523:psychology
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide
keywords: Antiangiogenic therapy; Metronomic chemotherapy; Uterine carcinosarcoma