Advanced Soft Tissue Sarcoma with Mark Agulnik, MD Case 2

Mark Agulnik, MD:The patient scenario is of a 61-year-old Caucasian woman who presents with an 11 cm uterine leiomyosarcoma, and, unfortunately, at the time of presentation, also had peritoneum and lung involvement. The patient was relatively fit with a performance status of 1.

When we look at soft tissue sarcomas, and specifically, here, uterine leiomyosarcoma, one has to question, what are her risk factors, and why did this patient develop metastatic disease versus other patients who maybe present with localized disease without metastatic disease? When we start to look at risk factors for metastatic disease, it is based on the histology of the tumor, it’s based on the location of the tumor, the size of the tumor, and the grade of the tumor, as well as the patient age.

When we start to look at prognosis for patients, and that, traditionally, is one of the questions they’ll ask in initial consultation, the prognosis of metastatic disease is quoted at about 16 to 18 months. The average patient will live that long, with half of them living beyond that and half of them living less than that.

For this patient, in particular, who has metastatic disease, given the extent of her disease and the number of organs involved, as well as the extent of involvement, we are not necessarily looking to cure this patient. What we’re looking to do is we’re looking to stabilize the disease, perhaps shrink the disease, and then allow the patient to maintain a quality of life, as well as longevity of life. What you’re trying to do is somehow mold the disease a little bit so that it becomes a chronic disease. It is something that she’ll always have with her, but maybe it’s not something that will shorten her life expectancy if she’s one of those who does better than the rest.