Uterine carcinosarcoma with microsatellite instability - does immunotherapy modify the therapeutic scenario? A case report and literature review

ABSTRACT

Carcinosarcomas were reclassified by World Health Organization as high-grade uterine carcinomas in 2014. Due to its rare histology, comprising only 5% of uterine carcinomas, there is a small representation of this tumor in studies that evaluate metastatic uterine carcinomas treatment. In 2022, the treatment of metastatic uterine carcinomas has changed dramatically with the inclusion of immunotherapy in the therapeutic arsenal, either as a monotherapy or in combination with lenvatinib. The status of microsatellites is paramount in the therapeutic decision for this tumor; carcinosarcoma patients haven’t been included in randomized trials so far. Here we report the case of a 60-year-old woman diagnosed with recurrent carcinosarcoma metastatic to the liver and pelvis. Immunohistochemistry demonstrated microsatellite instability (loss of MLH1 and PMS2 nuclear staining). She received immunotherapy with pembrolizumab every three weeks as monotherapy and after 4 cycles, she achieved a complete radiological response in the liver and a partial response in the pelvis.

RESUMO

Os carcinossarcomas foram reclassificados pela Organização Mundial de Saúde como carcinomas uterinos de alto grau em 2014. Devido à sua rara histologia, compreendendo apenas 5% dos carcinomas uterinos, há uma pequena representatividade desse tumor em estudos que avaliam o tratamento de carcinomas uterinos metastáticos. Em 2022, o tratamento dos carcinomas uterinos metastáticos mudou drasticamente com a inclusão da imunoterapia no arsenal terapêutico, seja em monoterapia ou em combinação com lenvatinibe. O estado dos microssatélites é fundamental na decisão terapêutica para este tumor; pacientes com carcinossarcoma não foram incluídos em estudos randomizados até o momento. Aqui relatamos o caso de uma mulher de 60 anos com diagnóstico de carcinossarcoma recidivado metastático para o fígado e pelve. A imuno-histoquímica demonstrou instabilidade microssatélite (perda da coloração nuclear MLH1 e PMS2). Ela recebeu imunoterapia com pembrolizumabe a cada três semanas em monoterapia e após 4 ciclos obteve resposta radiológica completa no fígado e resposta parcial na pelve.

Keywords:

Microsatellite instability - Carcinosarcoma - Immunotherapy - Endometrial neoplasms

Descritores:

Instabilidade de microssatélites - Carcinossarcoma - Imunoterapia - Neoplasias endometriais

Publication History

Received: 27 May 2023

Accepted: 10 July 2023

Article published online:
31 August 2023

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