Real-world comparison of doxorubicin-ifosfamide versus gemcitabine-docetaxel regimens in metastatic uterine leiomyosarcoma: a multicenter retrospective study.
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Tunbekici Salih, Sahin Gokhan, Yuksel Haydar Cagatay, Acar Caner, Akın Imge, Aslanhan Hasan, Iscı Mert, Kabaoglu Ceren, Bal Hamit, Sakin Abdullah, Coskun Alper, Seyyar Mustafa, Dilek Mehmet Sıddık, Kara Mahmut, Solmaz Ali, Demir Teyfik, Zin Evrican, Terzi Aytac, Kus Fatih, Kus Ilgın Koc, Arık Zafer, Aytac Ali, Demirkıran Özge, Demir Bilgin, Yesil Havva, Biter Sedat, Koseci Tolga, Bayram Ertugrul, Unsal Ahmet, Ozveren Ahmet, Sevınc Alper, Ozaskın Duygu, Baykara Meltem, Unlu Ahmet, Kus Arıf, Karacin Cengiz, Yalcıner Merih, Uyar Galip Can, Sutcuoglu Osman, Kaplan Esmanur, Sakalar Teoman, Sahin Elif, Emin Gamze, Yıldırım Atilla, Mordag Ceren, Ugurlu Irem, Hacıbekiroglu Ilhan, Tunbekici Ibrahim, Gursoy Pınar, Sanli Ulus Ali, Goker Erdem
Аннотация
METHODS: This retrospective cohort included 271 patients with advanced or metastatic uterine leiomyosarcoma treated between 2010 and 2023 across 30 centers in Turkey. Patients received either doxorubicin-ifosfamide (n = 142) or gemcitabine-docetaxel (n = 129) as first-line therapy. The primary endpoint was overall survival; secondary endpoints included progression-free survival, objective response rate, disease control rate, and safety. Adverse events were graded according to the Common Terminology Criteria for Adverse Events version 5.0, while survival outcomes were estimated using the Kaplan-Meier method and further analyzed with Cox proportional hazards models.
RESULTS: Median overall survival was 19.7 months with doxorubicin-ifosfamide and 20.2 months with gemcitabine-docetaxel (P = .26). Median progression-free survival was 5.5 months with doxorubicin-ifosfamide and 7.0 months with gemcitabine-docetaxel (P = .62). The objective response rate was numerically higher with gemcitabine-docetaxel (35% vs. 26%), although not statistically significant (P = .11). Grade 3-4 neutropenia (16% vs. 12%) and febrile neutropenia (7% vs. 6%) were more frequent with doxorubicin-ifosfamide.
CONCLUSIONS: In this largest-to-date real-world cohort of metastatic uterine leiomyosarcoma, doxorubicin-ifosfamide and gemcitabine-docetaxel demonstrated comparable survival outcomes. Gemcitabine-docetaxel, however, was associated with a more favorable hematologic safety profile. These findings support the clinical utility of both regimens while underscoring the need for prospective, biomarker-driven studies to refine treatment selection and improve personalization in this rare malignancy.