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Lu TF, Sun L, Shih YH, Chen YF, Fan CT, Wang SJ, Hsu ST, Liu CK, Hwang SF, Lu CH. A retrospective study evaluating the effect of trastuzumab addition to carboplatin/paclitaxel on overall survival in patients with advanced-stage HER2/neu-overexpressing uterine serous carcinoma or carcinosarcoma. BMC Med 2025; 23:99. [PMID: 39984939 PMCID: PMC11846311 DOI: 10.1186/s12916-025-03916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 01/28/2025] [Indexed: 02/23/2025] Open
Abstract
BACKGROUND Uterine serous carcinoma and carcinosarcoma are aggressive forms of endometrial cancer with poor survival outcomes. Trastuzumab, a human epidermal growth factor receptor-2 (HER2)-directed monoclonal antibody, has demonstrated tumoricidal efficacy. However, clinical data regarding its efficacy in uterine serous carcinoma are limited, and there are no clinical data available for uterine carcinosarcoma. Therefore, this study aimed to ascertain the efficacy and safety of adding trastuzumab to carboplatin and paclitaxel as a frontline treatment for advanced-stage HER2-overexpressing uterine serous carcinoma and carcinosarcoma. METHODS This retrospective study used deidentified data from electronic health records from the TriNetX Research Network. Participants were identified using International Classification of Diseases codes, and HER2 positivity was confirmed through immunohistochemistry or fluorescence in situ hybridisation. Propensity score matching was employed to reduce confounders, and survival outcomes and adverse events were assessed. RESULTS Following propensity score matching, 280 patients with advanced HER2-positive uterine serous carcinoma or carcinosarcoma were analysed. The group of patients treated with carboplatin/paclitaxel + trastuzumab (CP + T) showed a significantly prolonged median overall survival compared to those treated exclusively with CP (41 months versus 25.2 months, hazard ratio [HR] = 0.51, p = 0.002) in both advanced-stage uterine carcinosarcoma and serous carcinoma. Specifically, patients with uterine carcinosarcoma experienced a prolonged survival benefit (HR = 0.39, p < 0.0001) when trastuzumab was added to their chemotherapy regimen, which surpassed the survival benefit observed in patients with uterine serous carcinoma (HR = 0.56, p = 0.04). However, patients who received trastuzumab experienced increased rates of hypertension, diarrhoea, and left ventricular systolic dysfunction. CONCLUSIONS The addition of trastuzumab to frontline chemotherapy is effective in treating HER2-overexpressing uterine serous carcinoma and carcinosarcoma, particularly uterine carcinosarcoma. However, careful monitoring of adverse cardiac events is needed.
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Affiliation(s)
- Ting-Fang Lu
- Department of Obstetrics Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, Chung Shan Medical University, Taichung, Taiwan
| | - Lou Sun
- Department of Obstetrics Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Food and Nutrition, Providence University, Taichung, Taiwan
| | - Yu-Hsiang Shih
- Department of Obstetrics Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Yen-Fu Chen
- Department of Obstetrics Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Ting Fan
- Department of Obstetrics Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shao-Jing Wang
- Department of Obstetrics Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Tien Hsu
- Department of Obstetrics Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
- Centre for General Education, Ling Tung University, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Ku Liu
- Department of Obstetrics Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Animal Science and Biotechnology, Tung Hai University, Taichung, Taiwan
| | - Sheau-Feng Hwang
- Department of Obstetrics Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Palliative Care Unit, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chien-Hsing Lu
- Department of Obstetrics Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan.
- Institute of Biomedical Sciences, PhD Programme in Translational Medicine and the Rong-Hsing Research Centre for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan.
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Zhi W, Zhan Y, He C, Jin Y. Distinct histological and clinical features associated with pure uterine serous carcinoma: A single institution experience. Ann Diagn Pathol 2023; 66:152173. [PMID: 37352704 DOI: 10.1016/j.anndiagpath.2023.152173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023]
Abstract
AIM To ascertain the clinicopathological features, survival, and prognostic factors of pure uterine serous carcinoma (pUSC) and compare its clinicopathological characteristics with those of serous-like grade-3 endometrioid endometrial carcinoma (G3-EEC). METHOD Consecutive patients with pUSC and p53 abnormal (p53abn) G3-EEC were retrospectively selected between 2014 and 2022. Histological and immunohistochemical features were reviewed, clinical information was collected, and survival analyses were performed. RESULTS Eighty-five pUSC patients (mean age: 61.6 years) were included. Histologically, pUSC showed a predominantly glandular growth pattern (80.0 %) with high-grade nuclear atypia and obvious nucleoli and 53 cases showed admixtures of architectural patterns. The p53 aberrant expression rate was 98.8 %. 41.5 %, 53.7 %, and 67.5 % of cases were classified as negative for ER, PR, and WT1, respectively. Six (12.3 %) of 49 cases had a HER2 score of 3+ by immunohistochemistry (IHC). The overall survival and progression-free survival rates were 72.9 % and 63.5 %, respectively. Advanced stage, no adjuvant therapy, and lymph node metastasis were independent risk factors for poor survival in pUSC. Twenty-five p53abn G3-EEC patients were assessed. Women with p53abn G3-EEC were on average, younger than those with pUSC (53.4 vs. 61.6 years, P < 0.001). Papillary structures were observed more commonly in pUSC (16 % vs. 36.5 %, P = 0.042). Positive PR expression was significantly associated with p53abn G3-EEC (P = 0.009). Survival did not differ significantly between the subgroups in univariate and multivariate analyses. CONCLUSION In this contemporary series, we affirm the suboptimal prognosis associated with pUSC, and that the survival associated with pUSC and p53abn G3-EEC are not significantly different. pUSC and p53abn G3-EEC have distinct morphological and immunohistochemical characteristics.
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Affiliation(s)
- Wenxue Zhi
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yang Zhan
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Chunyan He
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yulan Jin
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China.
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Chen H, Molberg K, Carrick K, Niu S, Rivera Colon G, Gwin K, Lewis C, Zheng W, Castrillon DH, Lucas E. Prevalence and prognostic significance of PD-L1, TIM-3 and B7-H3 expression in endometrial serous carcinoma. Mod Pathol 2022; 35:1955-1965. [PMID: 35804040 DOI: 10.1038/s41379-022-01131-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/24/2022]
Abstract
Endometrial serous carcinoma (ESC) is an aggressive type of endometrial carcinoma with a poor prognosis. Immune checkpoint blockade has evolved as a novel treatment option for endometrial cancers; however, data on expression of immune checkpoints that may be potential targets for immunotherapy in ESC are limited. We analyzed the prevalence and prognostic significance of PD-L1, TIM-3 and B7-H3 immune checkpoints in 99 ESC and evaluated their correlation with CD8 + tumor infiltrating lymphocytes. Applying the tumor proportion score (TPS) with a cutoff of 1%, PD-L1, TIM-3 and B7-H3 expression was present in 17%, 10% and 93% of cases, respectively. Applying the combined positive score (CPS) with a cutoff of 1, PD-L1, TIM-3 and B7-H3 expression was present in 63%, 67% and 94% of cases, respectively. Expression of these markers was largely independent of one another. PD-L1 correlated with higher CD8 + T-cell density when evaluated by either TPS (p = 0.02) or CPS (p < 0.0001). TIM-3 correlated with CD8 + T-cell density when evaluated by CPS (p < 0.0001). PD-L1 positivity was associated with improved overall survival (p = 0.038) when applying CPS. No association between PD-L1 expression and survival was found using TPS, and there was no association between TIM-3 or B7-H3 positivity and survival by either TPS or CPS. Using TPS, PD-L1 correlated with a higher tumor stage but not with survival, whereas the converse was true when PD-L1 was evaluated by CPS, suggesting that PD-L1 expression in immune cells correlates with prognosis and is independent of tumor stage. In conclusion, PD-L1, TIM-3 and B7-H3 may be potential therapeutic targets in selected patients with ESC. Further investigation of their roles as predictive biomarkers is needed.
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Affiliation(s)
- Hao Chen
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, 75390, USA.,Department of Pathology, Parkland Hospital, Dallas, TX, 75235, USA
| | - Kyle Molberg
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, 75390, USA.,Department of Pathology, Parkland Hospital, Dallas, TX, 75235, USA
| | - Kelley Carrick
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, 75390, USA.,Department of Pathology, Parkland Hospital, Dallas, TX, 75235, USA
| | - Shuang Niu
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, 75390, USA.,Department of Pathology, Parkland Hospital, Dallas, TX, 75235, USA
| | - Glorimar Rivera Colon
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, 75390, USA.,Department of Pathology, Parkland Hospital, Dallas, TX, 75235, USA
| | - Katja Gwin
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, 75390, USA.,Department of Pathology, Parkland Hospital, Dallas, TX, 75235, USA
| | - Cheryl Lewis
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Wenxin Zheng
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, 75390, USA.,Department of Pathology, Parkland Hospital, Dallas, TX, 75235, USA.,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, 75390, USA.,Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Diego H Castrillon
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, 75390, USA.,Department of Pathology, Parkland Hospital, Dallas, TX, 75235, USA.,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, 75390, USA.,Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Elena Lucas
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, 75390, USA. .,Department of Pathology, Parkland Hospital, Dallas, TX, 75235, USA. .,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, 75390, USA.
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