Combination chemotherapy with carboplatin, paclitaxel and pegylated liposomal doxorubicin for advanced or recurrent carcinosarcoma of the uterus: Clinical experience of a single institution Dimitrios Pectasides a, ⁎ , Eirini Pectasides a , George Papaxoinis a , Nikolaos Xiros a , Constantinos Sykiotis b , Antonios Papachristodoulou c , Nikolaos Tountas a , John Panayiotides d , Theofanis Economopoulos a a 2nd Department of Internal Medicine, Propaedeutic, Oncology Section, University of Athens, “Attikon” University Hospital, Haidari, 1 Rimini, Athens, Greece b 3rd Department of Obstetrics and Gynecology, Oncology Section, University of Athens, “Attikon” University Hospital, Haidari, 1 Rimini, Athens, Greece c 2nd Department of Surgery, Propaedeutic, Oncology Section, University of Athens, “Laikon” University Hospital, Goudi, Mikras Asias, Athens, Greece d 2nd Department of Pathology, University of Athens, “Attikon” University Hospital, Haidari, 1 Rimini, Athens, Greece Received 2 May 2008 Available online 7 July 2008 Abstract Objectives. The purpose of this study was to evaluate the activity and toxicity of carboplatin, paclitaxel and pegylated liposomal doxorubicin combination in advanced or recurrent of the uterine carcinosarcoma. Methods. Twenty-nine eligible patients with measurable disease were treated with carboplatin [area under the curve (AUC) 5], paclitaxel 175mg/m 2 and pegylated liposomal doxorubicin 25 mg/m 2 every 3 weeks for 6–8 cycles. Results. There were 10 complete responses (CRs) (34%) and 8 partial responses (PRs) (28%) for an overall response rate (RR) of 62% (95% confidence interval [CI], 43–81%). The median progression-free survival (PFS) was 8.2 months (95% CI, 4.1–12.2 months) and the median overall survival (OS) was 16.4 months (95% CI, 14.7–18.0 months). There was no statistically significant difference between histology and response to therapy. Patients with PS of 0 or 1 had a higher RR than those with worst PS. Toxicity was generally mild except for myelotoxicity. Neutropenia grade 3/4 was recorded in 52% of patients and 10% experienced febrile neutropenia. Anemia grade 3 or 4 developed in 27% of patients and thrombocytopenia grade 3 or 4 in 31% of patients. Three patients (10%) developed grade 3 sensory neuropathy and only 2 patients (8%) grade 3 palmar-plantar erythrodysesthesias. No treatment-related deaths were recorded in our series. Conclusion. The combination of carboplatin, paclitaxel and pegylated liposomal doxorubicin appears to have activity in advanced, persistent or recurrent endometrial carcinosarcoma with an acceptable toxicity profile. © 2008 Elsevier Inc. All rights reserved. Keywords: Carboplatin; Paclitaxel; Pegylated liposomal doxorubicin; Chemotherapy; Uterine carcinosarcoma Introduction Uterine sarcomas are rare and aggressive malignancies accounting for only 3–5% of all uterine tumors [1]. Classifica- tion of uterine sarcomas is based on the cell type and the site of origin. Homologous tumors are composed of elements completely indigenous to the uterus. Heterologous lesions are composed of both uterine and nonuterine tissue. Carcinosar- coma of the uterus, also known as malignant mixed müllerian tumors, contains both carcinomatous and sarcomatous histolo- gic elements [2].The prognosis of uterine carcinosarcoma is extremely poor because of a high tendency to metastasize even after local therapy, surgery, radiotherapy or both. Approxi- mately 53% (homologous 44%, heterologous 63%) of patients with clinical stage I–II uterine carcinosarcomas recur within 5 years of initial therapy [3]. Adjuvant pelvic radiotherapy (51 Gy) leads to a reduction in local relapse but has no effect on PFS or OS due to the propensity of the disease to recur at distant sites [4–6]. The present standard of care for advanced or recurrent carcinosarcoma is systemic chemotherapy. Available online at www.sciencedirect.com Gynecologic Oncology 110 (2008) 299 – 303 www.elsevier.com/locate/ygyno ⁎ Corresponding author. Fax: +30 210 5831690, +30 210 6008610. E-mail addresses: pectasid@otenet.gr, hecogoff@otenet.gr (D. Pectasides). 0090-8258/$ - see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.ygyno.2008.05.017