Retreatment with aromatase inhibitor therapy in the management of granulosa cell tumor

Response to Systemic Therapies in Ovarian Adult Granulosa Cell Tumors: A Literature Review

Simple Summary

Adult granulosa cell tumors (aGCTs) are a rare subtype of ovarian cancer. First choice of treatment is surgery; when this is not possible, chemotherapy and anti-hormonal therapy are often used. There is limited evidence on the effect of systemic therapy in aGCT. The aim of our systematic review is to provide an overview of the response to chemotherapy and anti-hormonal therapy in patients with aGCT. We found very few articles reporting the response to chemotherapy and anti-hormonal therapy in only aGCT. The available data showed a moderate response to chemotherapy and anti-hormonal therapy, but if patients who achieve stable disease are also taken into account, the response is higher. This may mean that surgery can be postponed for a longer period of time.

Abstract

For adult granulosa cell tumors (aGCTs), the preferred treatment modality is surgery. Chemotherapy and anti-hormonal therapy are also frequently used in patients with recurrent aGCT. We aimed to review the existing literature on the response to chemotherapy and anti-hormonal therapy in patients with aGCT. Embase and MEDLINE were searched from inception to November 2021 for eligible studies. Objective response rate (ORR) was calculated as the total number of cases with a complete response (CR) or a partial response (PR). Disease control rate (DCR) was defined as the sum of cases with CR, PR or stable disease (SD). A total of 10 studies were included that reported on chemotherapy and 13 studies were included that reported on anti-hormonal therapy. The response rates of the 56 chemotherapy regimens that could be evaluated resulted in an ORR of 30% and DCR of 58%. For anti-hormonal therapy, the results of 73 regimens led to an ORR of 11% and a DCR of 66%. Evidence on systemic therapy in aGCT only is limited. For both chemotherapy and anti-hormonal therapy, the ORR is limited, but the response is considerably higher when patients achieving SD are included. New approaches are needed to provide more evidence and standardize treatment in aGCT.

Response of an ovarian granulosa cell tumor with everolimus and exemestane after initial response to letrozole

Granulosa cell tumors of the ovaries (GCTO), the most common sex cord tumors of the female genitalia, are characterized by a remarkably favorable prognosis but tend to recur even after several years of follow-up. Standard approach to manage these relapsing tumors is almost inexistent and physicians' choice is most commonly based on his/her personal expertise. Recently, the use of hormone therapy in GCTO has induced prolonged response and survival. In this case report, we report the first successful use of everolimus in the combination of exemestane to reverse the resistance to hormonal therapy with letrozole in a 53-year-old woman with GCTO.