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Researchers have charted the complex molecular biology of uterine carcinosarcoma (UCS), a rare and aggressive gynecologic cancer (Cancer Cell 2017;31(3):411).

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Using this new collection of genomic information, physicians will be better able to determine the specific genetic fingerprint of each patient's tumor and find treatment options that better suit them, said lead study author Douglas A. Levine, MD, Director of the Division of Gynecologic Oncology at NYU Langone Medical Center's Perlmutter Cancer Center.


He and his colleagues found that, while all UCS tumors share some genetic traits, there is great diversity among the tumors. Instead of having a few commonly mutated genes, UCS tumors were found to have mutations in genes that play a wider variety of roles in cancer biology than previously thought.


Thus, noted the authors, anti-cancer drugs, which work against specific genetic targets, are more likely to be effective against certain UCS tumors, but not against others, because there are so many different mixes of mutations. The study traced the molecular roots of UCS using genomic, epigenetic, transcriptomic, and proteomic analyses to create a "new genetic atlas" for the disease.


"The biggest surprise was the genetic variety within tumors of this type," said Levine, adding that the finding helps explain why UCS has been especially difficult to treat. However, it also points doctors toward possible treatments, some already approved and others currently in clinical studies.


This search for new options is urgent, added Levine, because only about one of every three women survives longer than 5 years after diagnosis with UCS.


Gene Analysis

This study was conducted using tissue samples from 57 women with confirmed cases of UCS. Of the 57 women sampled, 64 percent had the cancer recur within the study follow-up period and 58 percent died. The average follow-up period was 25.7 months.


Analysis of the 57 samples yielded 60,000 individual characteristics, which then were narrowed down to 9,149 genetic mutations. Based on this information, clinical data about UCS, and studies of other related cancers, the team identified five genes most commonly associated with UCS. One gene that normally protects against cancer, P53, was mutated in 91 percent of the tumors in the study.


In addition, UCS frequently has epithelial cells that can transition into a more harmful type of tumor-spurring, stem cell-like cancer cell, the researchers found. This trait, known as epithelial-mesenchymal transition (EMT), tends to defeat anti-cancer drugs, so newer research efforts aim to develop drugs that target EMT.


After an intensive molecular analysis of the tissue samples, the team also compared the UCS sample to data on other cancers in The Cancer Genome Atlas of the NCI and the National Human Genome Research Institute. The Cancer Genome Atlas is a central repository of genomic data gleaned from tissue samples from more than 11,000 people, providing reference details on 33 different cancers.


According to Levine, comparing traits of UCS tumors to these large databases has revealed that UCS may be related at the molecular level to entirely different kinds of cancer. Even though that means treating UCS remains difficult, this discovery could be good news for patients and their doctors, noted Levine. "Now, we can apply what we've learned to creating more specific clinical trials."


Successfully treating cancer requires interrupting the process that allows cancer cells to grow or spread to other organs. If doctors know the precise genetic mutation or mutations involved in an individual patient's cancer, they can select chemotherapy or other treatments known to work against similar tumors.


Uterine cancers include carcinomas that originate in epithelial cells, which line or cover most organs, and sarcomas that form in muscle, fat, or bone cells, as well as in cells in tendons or ligaments. UCS has features of cancers that start in endometrial cells of the uterine lining combined with features of cancers that start in uterine muscle or connective tissues.