Hormone Therapy for Uterine Sarcomas

Hormone therapy is the use of hormones or hormone-blocking drugs to fight cancer. Part of diagnosing uterine sarcoma includes lab tests that check the cancer cells to see if they have receptors where hormones can attach. If they do, they may respond to hormone treatment. Hormone therapy is mainly used to treat women with endometrial stromal sarcomas (ESS) and is rarely used for the other types of uterine sarcomas.

Progestins

Progestins are drugs that act like the hormone progesterone. The progestins used most often to treat uterine sarcomas are megestrol (Megace®) and medroxyprogesterone (Provera®). Both of these drugs are pills you take every day.

Side effects can include increased blood sugar levels in patients with diabetes. Hot flashes, night sweats, and weight gain (from fluid retention and an increased appetite) also occur. Rarely, serious blood clots are seen in patients taking progestins.

Gonadotropin-releasing hormone agonists

Gonadotropin-releasing hormone (GNRH) agonists keep the ovaries from making estrogen. These drugs are used to lower estrogen levels in women who are premenopausal. (Before menopause, almost all a woman's estrogen is made by the ovaries.) Examples of GNRH agonists include goserelin (Zoladex®) and leuprolide (Lupron®). These drugs are given as a shot every 1 to 3 months.

Side effects can include any of the symptoms of menopause, such as hot flashes and vaginal dryness. If they are taken for a long time, these drugs can weaken bones, sometimes leading to osteoporosis.

Aromatase inhibitors

After the ovaries are removed, or aren't working (after menopause), estrogen is still made in fat tissue. This becomes the body's main source of estrogen. Drugs called aromatase inhibitors can stop this estrogen from being made. Examples of aromatase inhibitors include letrozole (Femara®), anastrozole (Arimidex®), and exemestane (Aromasin®). These drugs are most often used to treat breast cancer, but they also might be helpful in treating endometrial stromal sarcoma. Because they don’t affect estrogen made by the ovaries, they are only useful in women whose ovaries have been removed or no longer work (like after menopause).

Side effects can include any of the symptoms of menopause, such as hot flashes and vaginal dryness, as well as joint/muscle pain. If they are taken for a long time (years), these drugs can weaken bones, sometimes leading to osteoporosis.

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Lee SW, Lee TS, Hong DG, et al. Practice guidelines for management of uterine corpus cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement. J Gynecol Oncol. 2017;28(1):e12.

National Cancer Institute. Uterine Sarcoma Treatment (PDQ®)–Patient Version. October 13, 2017. Accessed at www.cancer.gov/types/uterine/patient/uterine-sarcoma-treatment-pdq on October 25, 2017.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Uterine Neoplasms. Version 1.2018 -- October 13, 2017. 

Last Medical Review: October 12, 2017 Last Revised: November 13, 2017

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