Chemotherapy for Uterine Sarcomas

Chemotherapy (chemo) is the use of anti-cancer drugs to treat cancer. The drugs can be taken by mouth as pills or injected by needle into a vein or muscle. These drugs enter the bloodstream and can reach almost all areas of the body, making this treatment useful for killing cancer cells in most parts of the body. This makes chemo a useful treatment for cancer that has spread outside of the uterus.

Not all women with uterine sarcoma will need chemo, but there are a few situations in which chemo might be recommended:

• After surgery (adjuvant therapy) chemo might be used to help keep the cancer from coming back later.
• Chemo might be used as the main therapy to treat the cancer if you are unable to have surgery.
• Sometimes chemo might be used to control uterine sarcoma that has spread to other parts of the body or come back after surgery. In this case, the goal may be to ease symptoms and try to keep the tumor from growing.

Chemo may not work for certain types of uterine sarcoma. And some types of uterine sarcoma have been found to respond better to certain drugs and drug combinations. The role of chemo, as well as the best chemo drugs to use are not clear. Still, a lot of clinical trials are looking at this.

Some of the drugs commonly used to treat uterine sarcomas include:

• Doxorubicin (Adriamycin)
• Docetaxel (Taxotere)
• Gemcitabine (Gemzar)
• Ifosfamide (Ifex)
• Dacarbazine (DTIC)
• Vinorelbine (Navelbine)
• Liposomal doxorubicin (Doxil)
• Epirubicin (Ellence)
• Temozolomide (Temodar)
• Trabectedin (Yondelis)

Sometimes, more than one drug is used. For example, gemcitabine and docetaxel are often used together to treat leiomyosarcoma.

Side effects of chemotherapy for uterine sarcoma

These drugs kill cancer cells but can also damage some normal cells. This is what causes many side effects. Side effects of chemo depend on the specific drugs, the amount taken, and the length of time you are treated.

Many side effects are short-term and go away after treatment is finished, but some can last a long time or even be permanent. It's important to tell your health care team if you have any side effects, as there are often ways to lessen them.

Some common chemo side effects include:

• Nausea and vomiting
• Loss of appetite
• Hair loss
• Mouth sores
• Feeling tired (fatigue)

Chemo can damage the blood-producing cells of the bone marrow, leading to low blood cell counts. This can cause:

• An increased chance of infection from a shortage of white blood cells (neutropenia)
• Problems with bleeding or bruising from a shortage of blood platelets (thrombocytopenia)
• Feeling tired or short of breath due to low red blood cell counts (anemia)

Some side effects from chemotherapy can last a long time. For example, the drug doxorubicin can damage the heart muscle over time. The chance of heart damage goes up as the total dose of the drug goes up, so doctors limit how much doxorubicin can be given.