Skip to main content
Top
Published in: BMC Cancer 1/2018

Open Access 01-12-2018 | Research article

Comparison of first-line chemotherapy regimens for ovarian carcinosarcoma: a single institution case series and review of the literature

Authors: Melissa Brackmann, Marina Stasenko, Shitanshu Uppal, Jake Erba, R. Kevin Reynolds, Karen McLean

Published in: BMC Cancer | Issue 1/2018

Login to get access

Abstract

Background

The optimal first-line chemotherapy for ovarian carcinosarcoma has not yet been determined. We therefore sought to determine the progression-free survival (PFS) and overall survival (OS) for patients with ovarian carcinosarcoma treated at our institution with different first-line chemotherapy regimens.

Methods

This single-institution, retrospective analysis included all patients with ovarian or primary peritoneal carcinosarcoma diagnosed from September 1996 to July 2017. Kaplan Meier analysis with a log-rank Mantel-Cox test was used to compare PFS and OS between treatment groups, and a p-value of < 0.05 was considered statistically significant.

Results

Thirty-one patients met inclusion criteria: two patients were stage IC, 5 were stage II, 21 were stage III, and 3 were stage IV. The median PFS and OS for all stages was 9.3 and 19.7 months respectively. Fifteen patients (48%) received carboplatin/paclitaxel as first therapy, 7 (23%) received ifosfamide/paclitaxel, 6 (19%) received a different regimen, and 3 (10%) did not receive chemotherapy. Patients treated with carboplatin/paclitaxel had a statistically significant longer PFS when compared to those receiving ifosfamide/paclitaxel (17.8 vs. 8.0 months, p = 0.025). OS was similar between all comparisons.

Conclusions

In summary, in our cohort of ovarian carcinosarcoma patients, median PFS is longer in patients treated with carboplatin/paclitaxel compared to ifosfamide/paclitaxel. Overall survival was similar for all treatment groups, potentially due to subsequent treatment crossover. Given the rarity and aggressive nature of this tumor, further study into optimal first-line chemotherapy is warranted.
Literature
1.
go back to reference Pacaut C, Bourmaud A, Rivoirard R, Moriceau G, Guy JB, Collard O, Bosacki C, Jacquin JP, Levy A, Chauleur C, et al. Uterine and ovary carcinosarcomas: outcome, prognosis factors, and adjuvant therapy. Am J Clin Oncol. 2015;38(3):272–7.CrossRefPubMed Pacaut C, Bourmaud A, Rivoirard R, Moriceau G, Guy JB, Collard O, Bosacki C, Jacquin JP, Levy A, Chauleur C, et al. Uterine and ovary carcinosarcomas: outcome, prognosis factors, and adjuvant therapy. Am J Clin Oncol. 2015;38(3):272–7.CrossRefPubMed
2.
go back to reference Schipf A, Mayr D, Kirchner T, Diebold J. Molecular genetic aberrations of ovarian and uterine carcinosarcomas--a CGH and FISH study. Virchows Arch. 2008;452(3):259–68.CrossRefPubMed Schipf A, Mayr D, Kirchner T, Diebold J. Molecular genetic aberrations of ovarian and uterine carcinosarcomas--a CGH and FISH study. Virchows Arch. 2008;452(3):259–68.CrossRefPubMed
3.
go back to reference Yamada SD, Burger RA, Brewster WR, Anton D, Kohler MF, Monk BJ. Pathologic variables and adjuvant therapy as predictors of recurrence and survival for patients with surgically evaluated carcinosarcoma of the uterus. Cancer. 2000;88(12):2782–6.CrossRefPubMed Yamada SD, Burger RA, Brewster WR, Anton D, Kohler MF, Monk BJ. Pathologic variables and adjuvant therapy as predictors of recurrence and survival for patients with surgically evaluated carcinosarcoma of the uterus. Cancer. 2000;88(12):2782–6.CrossRefPubMed
4.
go back to reference Rauh-Hain JA, Diver EJ, Clemmer JT, Bradford LS, Clark RM, Growdon WB, Goodman AK, Boruta DM 2nd, Schorge JO, del Carmen MG. Carcinosarcoma of the ovary compared to papillary serous ovarian carcinoma: a SEER analysis. Gynecol Oncol. 2013;131(1):46–51.CrossRefPubMed Rauh-Hain JA, Diver EJ, Clemmer JT, Bradford LS, Clark RM, Growdon WB, Goodman AK, Boruta DM 2nd, Schorge JO, del Carmen MG. Carcinosarcoma of the ovary compared to papillary serous ovarian carcinoma: a SEER analysis. Gynecol Oncol. 2013;131(1):46–51.CrossRefPubMed
5.
go back to reference Rauh-Hain JA, Birrer M, Del Carmen MG. Carcinosarcoma of the ovary, fallopian tube, and peritoneum: prognostic factors and treatment modalities. Gynecol Oncol. 2016;142(2):248–54.CrossRefPubMed Rauh-Hain JA, Birrer M, Del Carmen MG. Carcinosarcoma of the ovary, fallopian tube, and peritoneum: prognostic factors and treatment modalities. Gynecol Oncol. 2016;142(2):248–54.CrossRefPubMed
6.
go back to reference Brown E, Stewart M, Rye T, Al-Nafussi A, Williams AR, Bradburn M, Smyth J, Gabra H. Carcinosarcoma of the ovary: 19 years of prospective data from a single center. Cancer. 2004;100(10):2148–53.CrossRefPubMed Brown E, Stewart M, Rye T, Al-Nafussi A, Williams AR, Bradburn M, Smyth J, Gabra H. Carcinosarcoma of the ovary: 19 years of prospective data from a single center. Cancer. 2004;100(10):2148–53.CrossRefPubMed
7.
go back to reference George EM, Herzog TJ, Neugut AI, Lu YS, Burke WM, Lewin SN, Hershman DL, Wright JD. Carcinosarcoma of the ovary: natural history, patterns of treatment, and outcome. Gynecol Oncol. 2013;131(1):42–5.CrossRefPubMedPubMedCentral George EM, Herzog TJ, Neugut AI, Lu YS, Burke WM, Lewin SN, Hershman DL, Wright JD. Carcinosarcoma of the ovary: natural history, patterns of treatment, and outcome. Gynecol Oncol. 2013;131(1):42–5.CrossRefPubMedPubMedCentral
8.
go back to reference Mano MS, Rosa DD, Azambuja E, Ismael G, Braga S, D'Hondt V, Piccart M, Awada A. Current management of ovarian carcinosarcoma. Int J Gynecol Cancer. 2007;17(2):316–24.CrossRefPubMed Mano MS, Rosa DD, Azambuja E, Ismael G, Braga S, D'Hondt V, Piccart M, Awada A. Current management of ovarian carcinosarcoma. Int J Gynecol Cancer. 2007;17(2):316–24.CrossRefPubMed
9.
go back to reference Homesley HD, Filiaci V, Markman M, Bitterman P, Eaton L, Kilgore LC, Monk BJ, Ueland FR, Gynecologic Oncology G. Phase III trial of ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: a gynecologic oncology group study. J Clin Oncol. 2007;25(5):526–31.CrossRefPubMed Homesley HD, Filiaci V, Markman M, Bitterman P, Eaton L, Kilgore LC, Monk BJ, Ueland FR, Gynecologic Oncology G. Phase III trial of ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: a gynecologic oncology group study. J Clin Oncol. 2007;25(5):526–31.CrossRefPubMed
10.
go back to reference Galaal K, van der Heijden E, Godfrey K, Naik R, Kucukmetin A, Bryant A, Das N, Lopes AD. Adjuvant radiotherapy and/or chemotherapy after surgery for uterine carcinosarcoma. The Cochrane database of systematic reviews. 2013;2:CD006812. Galaal K, van der Heijden E, Godfrey K, Naik R, Kucukmetin A, Bryant A, Das N, Lopes AD. Adjuvant radiotherapy and/or chemotherapy after surgery for uterine carcinosarcoma. The Cochrane database of systematic reviews. 2013;2:CD006812.
11.
go back to reference Powell MA, Filiaci VL, Rose PG, Mannel RS, Hanjani P, Degeest K, Miller BE, Susumu N, Ueland FR. Phase II evaluation of paclitaxel and carboplatin in the treatment of carcinosarcoma of the uterus: a gynecologic oncology group study. J Clin Oncol. 2010;28(16):2727–31.CrossRefPubMedPubMedCentral Powell MA, Filiaci VL, Rose PG, Mannel RS, Hanjani P, Degeest K, Miller BE, Susumu N, Ueland FR. Phase II evaluation of paclitaxel and carboplatin in the treatment of carcinosarcoma of the uterus: a gynecologic oncology group study. J Clin Oncol. 2010;28(16):2727–31.CrossRefPubMedPubMedCentral
12.
go back to reference Lacour RA, Euscher E, Atkinson EN, Sun CC, Ramirez PT, Coleman RL, Brown J, Gano JB, Burke TW, Ramondetta LM. A phase II trial of paclitaxel and carboplatin in women with advanced or recurrent uterine carcinosarcoma. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2011;21(3):517–22.CrossRef Lacour RA, Euscher E, Atkinson EN, Sun CC, Ramirez PT, Coleman RL, Brown J, Gano JB, Burke TW, Ramondetta LM. A phase II trial of paclitaxel and carboplatin in women with advanced or recurrent uterine carcinosarcoma. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2011;21(3):517–22.CrossRef
13.
go back to reference Kanis MJ, Kolev V, Getrajdman J, Zakashansky K, Cohen C, Rahaman J. Carcinosarcoma of the ovary: a single institution experience and review of the literature. Eur J Gynaecol Oncol. 2016;37(1):75–9.PubMed Kanis MJ, Kolev V, Getrajdman J, Zakashansky K, Cohen C, Rahaman J. Carcinosarcoma of the ovary: a single institution experience and review of the literature. Eur J Gynaecol Oncol. 2016;37(1):75–9.PubMed
14.
go back to reference Rutledge TL, Gold MA, McMeekin DS, Huh WK, Powell MA, Lewin SN, Mutch DG, Johnson GA, Walker JL, Mannel RS. Carcinosarcoma of the ovary-a case series. Gynecol Oncol. 2006;100(1):128–32.CrossRefPubMed Rutledge TL, Gold MA, McMeekin DS, Huh WK, Powell MA, Lewin SN, Mutch DG, Johnson GA, Walker JL, Mannel RS. Carcinosarcoma of the ovary-a case series. Gynecol Oncol. 2006;100(1):128–32.CrossRefPubMed
15.
go back to reference Silasi DA, Illuzzi JL, Kelly MG, Rutherford TJ, Mor G, Azodi M, Schwartz PE. Carcinosarcoma of the ovary. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2008;18(1):22–9.CrossRef Silasi DA, Illuzzi JL, Kelly MG, Rutherford TJ, Mor G, Azodi M, Schwartz PE. Carcinosarcoma of the ovary. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2008;18(1):22–9.CrossRef
16.
go back to reference Duska LR, Garrett A, Eltabbakh GH, Oliva E, Penson R, Fuller AF. Paclitaxel and platinum chemotherapy for malignant mixed mullerian tumors of the ovary. Gynecol Oncol. 2002;85(3):459–63.CrossRefPubMed Duska LR, Garrett A, Eltabbakh GH, Oliva E, Penson R, Fuller AF. Paclitaxel and platinum chemotherapy for malignant mixed mullerian tumors of the ovary. Gynecol Oncol. 2002;85(3):459–63.CrossRefPubMed
17.
go back to reference Rauh-Hain JA, Growdon WB, Rodriguez N, Goodman AK, Boruta DM 2nd, Schorge JO, Horowitz NS, del Carmen MG. Carcinosarcoma of the ovary: a case-control study. Gynecol Oncol. 2011;121(3):477–81.CrossRefPubMed Rauh-Hain JA, Growdon WB, Rodriguez N, Goodman AK, Boruta DM 2nd, Schorge JO, Horowitz NS, del Carmen MG. Carcinosarcoma of the ovary: a case-control study. Gynecol Oncol. 2011;121(3):477–81.CrossRefPubMed
18.
go back to reference Herzog TJ, Armstrong DK, Brady MF, Coleman RL, Einstein MH, Monk BJ, Mannel RS, Thigpen JT, Umpierre SA, Villella JA, et al. Ovarian cancer clinical trial endpoints: Society of Gynecologic Oncology white paper. Gynecol Oncol. 2014;132(1):8–17.CrossRefPubMed Herzog TJ, Armstrong DK, Brady MF, Coleman RL, Einstein MH, Monk BJ, Mannel RS, Thigpen JT, Umpierre SA, Villella JA, et al. Ovarian cancer clinical trial endpoints: Society of Gynecologic Oncology white paper. Gynecol Oncol. 2014;132(1):8–17.CrossRefPubMed
19.
go back to reference Shylasree TS, Bryant A, Athavale R. Chemotherapy and/or radiotherapy in combination with surgery for ovarian carcinosarcoma. The Cochrane database of systematic reviews. 2013;2:CD006246. Shylasree TS, Bryant A, Athavale R. Chemotherapy and/or radiotherapy in combination with surgery for ovarian carcinosarcoma. The Cochrane database of systematic reviews. 2013;2:CD006246.
20.
go back to reference Cicin I, Saip P, Eralp Y, Selam M, Topuz S, Ozluk Y, Aydin Y, Topuz E. Ovarian carcinosarcomas: clinicopathological prognostic factors and evaluation of chemotherapy regimens containing platinum. Gynecol Oncol. 2008;108(1):136–40.CrossRefPubMed Cicin I, Saip P, Eralp Y, Selam M, Topuz S, Ozluk Y, Aydin Y, Topuz E. Ovarian carcinosarcomas: clinicopathological prognostic factors and evaluation of chemotherapy regimens containing platinum. Gynecol Oncol. 2008;108(1):136–40.CrossRefPubMed
21.
go back to reference Leiser AL, Chi DS, Ishill NM, Tew WP. Carcinosarcoma of the ovary treated with platinum and taxane: the memorial Sloan-Kettering cancer center experience. Gynecol Oncol. 2007;105(3):657–61.CrossRefPubMed Leiser AL, Chi DS, Ishill NM, Tew WP. Carcinosarcoma of the ovary treated with platinum and taxane: the memorial Sloan-Kettering cancer center experience. Gynecol Oncol. 2007;105(3):657–61.CrossRefPubMed
22.
go back to reference Loizzi V, Cormio G, Camporeale A, Falagario M, De Mitri P, Scardigno D, Putignano G, Selvaggi LE. Carcinosarcoma of the ovary: analysis of 13 cases and review of the literature. Oncology. 2011;80(1–2):102–6.CrossRefPubMed Loizzi V, Cormio G, Camporeale A, Falagario M, De Mitri P, Scardigno D, Putignano G, Selvaggi LE. Carcinosarcoma of the ovary: analysis of 13 cases and review of the literature. Oncology. 2011;80(1–2):102–6.CrossRefPubMed
23.
go back to reference Inthasorn P, Beale P, Dalrymple C, Carter J. Malignant mixed mullerian tumour of the ovary: prognostic factor and response of adjuvant platinum-based chemotherapy. Aust N Z J Obstet Gynaecol. 2003;43(1):61–4.CrossRefPubMed Inthasorn P, Beale P, Dalrymple C, Carter J. Malignant mixed mullerian tumour of the ovary: prognostic factor and response of adjuvant platinum-based chemotherapy. Aust N Z J Obstet Gynaecol. 2003;43(1):61–4.CrossRefPubMed
24.
go back to reference Sit AS, Price FV, Kelley JL, Comerci JT, Kunschner AJ, Kanbour-Shakir A, Edwards RP. Chemotherapy for malignant mixed Mullerian tumors of the ovary. Gynecol Oncol. 2000;79(2):196–200.CrossRefPubMed Sit AS, Price FV, Kelley JL, Comerci JT, Kunschner AJ, Kanbour-Shakir A, Edwards RP. Chemotherapy for malignant mixed Mullerian tumors of the ovary. Gynecol Oncol. 2000;79(2):196–200.CrossRefPubMed
25.
go back to reference Jernigan AM, Fader AN, Nutter B, Rose P, Tseng JH, Escobar PF. Ovarian carcinosarcoma: effects of cytoreductive status and platinum-based chemotherapy on survival. Obstet Gynecol Int. 2013;2013:490508.CrossRefPubMedPubMedCentral Jernigan AM, Fader AN, Nutter B, Rose P, Tseng JH, Escobar PF. Ovarian carcinosarcoma: effects of cytoreductive status and platinum-based chemotherapy on survival. Obstet Gynecol Int. 2013;2013:490508.CrossRefPubMedPubMedCentral
26.
go back to reference Costa MJ, Vogelsan J, Young LJ. p53 gene mutation in female genital tract carcinosarcomas (malignant mixed mullerian tumors): a clinicopathologic study of 74 cases. Mod Pathol. 1994;7(6):619–27.PubMed Costa MJ, Vogelsan J, Young LJ. p53 gene mutation in female genital tract carcinosarcomas (malignant mixed mullerian tumors): a clinicopathologic study of 74 cases. Mod Pathol. 1994;7(6):619–27.PubMed
27.
go back to reference Glaser G, Weroha SJ, Becker MA, Hou X, Enderica-Gonzalez S, Harrington SC, Haluska P. Conventional chemotherapy and oncogenic pathway targeting in ovarian carcinosarcoma using a patient-derived tumorgraft. PLoS One. 2015;10(5):e0126867.CrossRefPubMedPubMedCentral Glaser G, Weroha SJ, Becker MA, Hou X, Enderica-Gonzalez S, Harrington SC, Haluska P. Conventional chemotherapy and oncogenic pathway targeting in ovarian carcinosarcoma using a patient-derived tumorgraft. PLoS One. 2015;10(5):e0126867.CrossRefPubMedPubMedCentral
Metadata
Title
Comparison of first-line chemotherapy regimens for ovarian carcinosarcoma: a single institution case series and review of the literature
Authors
Melissa Brackmann
Marina Stasenko
Shitanshu Uppal
Jake Erba
R. Kevin Reynolds
Karen McLean
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-018-4082-6

Other articles of this Issue 1/2018

BMC Cancer 1/2018 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine