Is there any evidence of effective treatment of low grade endometrial
stromal sarcoma (ESS) by the drug GLIVEC (manufactured by the swiss
company NOVARTIS) ?

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Request for Question Clarification by kevinmd-ga on 13 Mar 2003 08:37 PST

Hello - thanks for asking your question.

I was not able to find via a Medline search information on Gleevac and
uterine sarcomas.  Gleevac is typically used in gastrointestinal
stromal tumors (GISTs) (of which there are definite studies on) and
chronic myelogenous leukemia.

For uterine sarcomas, doxorubicin, cisplatin, and ifosfamide are most
commonly used.  There is data on the other following regimens:
i) the combination of adjuvant cyclophosphamide, vincristine,
doxorubicin, and dacarbazine.
ii) the combination gemcitabine plus docetaxel for advanced or
metastatic disease.
iii) paclitaxel for advanced disease.
iv) cisplatin and ifosfamide for advanced disease.

I will be happy to give information on the use of Gleevec in the
setting of gastrointestial sarcomas, or more information on the
chemotherapy options for low grade endometrial sarcomas.

Thanks,
Kevin, M.D.

Hi airub,

Gleevec is being used for certain types of gynecologic CA.  I must
admit the research is a bit over my understanding level to answer
adequately.
http://www.cancerwise.org/September_2002/display.cfm?id=D0D3BA1E-09FB-4216-B521477147EFC620&method=displayFull&color=green

Best of luck to you,
V

Please check this recent reference, which is still being indexed by
Pubmed (see at the bottom of this comment):

Unfortunately, the author thinks that it appears that patients
suffering ESS and receiving Glivec or Gleevac (also known as STI-571
or imatinib), are unlikely to get a benefit. Please note that this is
only one article with results of basic experiments, not clinical
studies. Results may differ in clinical trials. However, I think that
conclusive evidence (not only of effectiveness, but also of
ineffectiveness) is still lacking. BTW, note that the link gently
offered by voila-ga refers to ovarian cancer, not ESS.

Int J Gynecol Pathol 2003 Apr;22(2):181-4 
  
Lack of Expression of c-kit Protein (CD117) in Mesenchymal Tumors of
the Uterus and Ovary.

Klein WM, Kurman RJ.

c-kit is a proto-oncogene that codes for a transmembrane tyrosine
kinase receptor (CD117). The gene product KIT is constitutively
overexpressed in mastocytosis and gastrointestinal stromal tumors.
Recently the use of the tyrosine kinase inhibitors, such as STI-571,
has resulted in the successful treatment of bcr-abl-positive leukemias
and gastrointestinal stromal tumors. In gastrointestinal stromal
tumors, immunostaining for c-kit is diffusely positive. Because the
expression of c-kit in mesenchymal tumors of the uterus and ovary has
not been previously studied, we evaluated its expression in 38 of
these tumors by immunohistochemistry. The number of positive
labeled/total tumors were as follows: 0/8 malignant mullerian mixed
tumors, 4/7 ovarian fibrosarcomas, 0/1 clear-cell ovarian sarcoma, 0/4
uterine leiomyosarcomas, 1/10 low-grade endometrial stromal sarcomas,
0/2 high-grade endometrial stromal sarcomas, and 3/6 endometrial
stromal nodules. In all positive cases, no more than 5% of the cells
were labeled. In conclusion, unlike gastrointestinal stromal tumors,
mesenchymal tumors of the uterus and ovary rarely express c-kit.
Therefore, it is unlikely that patients with these tumors will benefit
from treatment with the currently available tyrosine kinase
inhibitors.

PMID: 12649674 [PubMed - in process]