Department of Obstetrics and Gynecology, University of Virginia Health System, PO Box 800712, Charlottesville, VA 22908, USA.
Int J Gynecol Cancer. 2010 Jan;20(1):120-5. doi: 10.1111/IGC.0b013e3181c7fe53.
Our objective was to retrospectively review temozolomide in advanced and recurrent uterine leiomyosarcoma and to determine if tumor O-methylguanine DNA methyltransferase (MGMT) expression correlated with clinical response.
All patients with advanced or recurrent uterine leiomyosarcoma who received temozolomide during treatment were retrospectively identified. Relevant clinical and pathologic data were collected and compared. O-Methylguanine DNA methyltransferase expression was assessed by immunohistochemistry and scored by a gynecologic pathologist blinded to clinical outcomes.
From 1999 to 2008, 9 cases of leiomyosarcoma were diagnosed; 6 patients received temozolomide. Median follow-up was 54 months (range, 4-114 months). There was 1 patient with complete response, 1 durable partial response (27+ months), 3 stable disease (range, 3-10 months), and 1 progressive disease. Overall, 5 out of 6 patients derived clinical benefit. The patient with a complete response recurred 18 months after her last cycle. Median progression free interval was 15.4 months (95% confidence interval, 9.4-21.4). Two patients died of disease. Temozolomide was well tolerated with no dose-limiting toxicities, and no dose adjustments were required in 64 prescribed cycles. The MGMT expression was inversely correlated with response to temozolomide. Patients with tumors negative for MGMT expression had a median progression free interval of 18.5 months compared with 3 months for those whose tumors were positive, although not statistically significant.
Temozolomide is an easily administered, well-tolerated chemotherapeutic option in advanced or recurrent uterine leiomyosarcomas with a reasonable response rate. Assessment of MGMT expression may identify a subset of patients that will respond optimally to this therapy.
我们的目的是回顾替莫唑胺在晚期和复发性子宫平滑肌肉瘤中的应用，并确定肿瘤 O-甲基鸟嘌呤 DNA 甲基转移酶（MGMT）表达是否与临床反应相关。
回顾性地确定了在治疗期间接受替莫唑胺治疗的所有晚期或复发性子宫平滑肌肉瘤患者。收集了相关的临床和病理数据，并进行了比较。通过免疫组织化学评估 O-甲基鸟嘌呤 DNA 甲基转移酶的表达，并由一位对临床结果不知情的妇科病理学家进行评分。
1999 年至 2008 年，诊断出 9 例平滑肌肉瘤患者；其中 6 例患者接受了替莫唑胺治疗。中位随访时间为 54 个月（范围为 4-114 个月）。1 例患者完全缓解，1 例持久部分缓解（27+个月），3 例稳定疾病（3-10 个月），1 例进展性疾病。总体而言，6 例患者中有 5 例获得了临床获益。完全缓解的患者在最后一个周期后 18 个月复发。无进展生存期的中位数为 15.4 个月（95%置信区间，9.4-21.4）。有 2 例患者死于疾病。替莫唑胺耐受性良好，没有剂量限制毒性，在 64 个规定的周期中不需要调整剂量。MGMT 表达与替莫唑胺的反应呈负相关。MGMT 表达阴性的肿瘤患者的中位无进展生存期为 18.5 个月，而 MGMT 表达阳性的肿瘤患者为 3 个月，尽管无统计学意义。
替莫唑胺是一种易于管理、耐受性良好的化疗选择，在晚期或复发性子宫平滑肌肉瘤中有合理的反应率。评估 MGMT 表达可能会确定一组对这种治疗反应最佳的患者。
