How would you approach the primary treatment of a rapidly growing uterine carcinosarcoma with local extension through the anterior abdominal wall?
If considering systemic therapy, would you consider standard chemotherapy or use biomarker-directed therapy (e.g., imatinib if ckit+, larotrectinib/entrectinib if NTRK fusion identified, or immune checkpoint inhibitor if MSI, dMMR, TMB-H, or PD-L1+)?
Answer from: Medical Oncologist at Academic Institution
This patient needs multimodal therapy - surgical resection is a mainstay of treatment followed by adjuvant therapy (most likely chemotherapy +/- vaginal brachytherapy). In terms of chemotherapy agents - up front adjuvant treatment is usually carboplatin/paclitaxel or ifosfamide/paclitaxel. I would p...
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Answer from: Radiation Oncologist at Academic Institution
Sounds like non-metastatic disease if it is all local growth. If resectable, take for upfront surgery followed by adjuvant therapy as appropriate.
If not immediately resectable and node negative, would generally recommend neoadjuvant RT +/- concurrent chemotherapy to shrink then take for surgery, f...