Potential Benefit of Hormonal Therapy for Non-Uterine Soft Tissue Sarcoma (STS)

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 326-337-Hormone-Dependent Tumors
Bench to Bedside
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-328
Li Li*1, Robin Jacob2, Isaiah P Schuster3, Kenneth Howell Hupart4 and Vladimir Gotlieb1
1Nassau University Medical Center, East Meadow, NY, 2Howard University Hospital, Washington, DC, 3School of Medicine, Stony Brook University, Stony Brook, NY, 4Nassau Univ Med Ctr, East Meadow, NY
Background:

The expression of hormone receptors(HR) is considered a good prognostic marker in uterine sarcoma. Hormonal therapy is widely employed in the therapy of HR+ breast and gynecologic cancers, however, there is little information concerning hormonal therapy in HR+ extrauterine sarcoma.

Case:

59 y.o. woman with a history of schizophrenia and seizures presented after a fall. Past Surgery: hysterectomy 20 years ago for fibroids. PEx: mass in the left axilla. Routine lab tests were normal. CT trauma protocol revealed a 6x4 cm mass adjacent to the R kidney. Contrast MRI revealed an enhancing mass inseparable from the kidney. Its serpentine venous drainage to the IVC magnified the suspicion of malignancy. Thoracic CT showed a 3x2 cm node in the left axilla and a 1 cm nodule in the upper lobe of the right lung. An ultrasound-guided biopsy of the kidney and lymph node both showed atypical nuclei with spindle shaped cells. Immunohistochemistry confirmed the diagnosis of leiomyosarcoma with positive immunostaining for smooth muscle actin, vimentin, BCL-2 and CD-99. It also stained for estrogen and progesterone receptors.

We started chemotherapy with Gemcitabine and Paclitaxel. At 24 months her disease remained stable and Tamoxifen was added. Repeat CT scan 3 months later revealed a new 5x3 cm paraspinal mass. CT guided biopsy identified metastatic malignant melanoma. This was managed with palliative radiation therapy and Dacarbazine. The patient expired 1 year later.

Discussion:

The treatment of localized STS requires surgery and adjunctive radiation therapy. When metastases are present, combination chemotherapy is indicated. This approach is burdened by the limited number of medications available and by poor survival outcomes. HR expression has been found to confer better clinical outcomes in patients with uterine STS; this observation has been extended to  STS of non-uterine origin and those that arise in men. Despite emerging reports about the potential benefit of hormonal therapy-selective estrogen and progesterone receptor modulators and aromatase inhibitors-for uterine sarcoma, there is a paucity of information regarding the application of these therapies to sarcomas arising at other sites. Our patient survived significantly longer than expected with the diagnosis of metastatic retroperitoneal sarcoma. In part this may be due to the survival benefit associated with HR+ tumors, but it may also indicate a role for hormonal therapy which has yet to be explored.

Nothing to Disclose: LL, RJ, IPS, KHH, VG

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm