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Uterine carcinosarcoma is a two-faced cancer with a carcinoma part and a sarcoma-like part that both come from the same faulty epithelial cell. It is treated as a high-grade endometrial cancer, with surgery, carboplatin-paclitaxel and often radiotherapy, and its frequent HER2 expression is opening a route to antibody-drug conjugates.
Carcinosarcoma contains both a carcinomatous component, usually serous or high-grade endometrioid, and a sarcomatous component, which may resemble fibrosarcoma, leiomyosarcoma or heterologous tissue such as cartilage or skeletal muscle. Sequencing shows that both components share the same TP53, PIK3CA, FBXW7 and PPP2R1A mutations, so the tumour is a carcinoma that has undergone epithelial-to-mesenchymal transition rather than a true sarcoma, and it is classified and staged as an endometrial carcinoma. Almost all are p53-abnormal; a minority are mismatch-repair deficient and a few POLE-ultramutated, and HER2 is expressed or amplified in a substantial minority. Patients are older than average, tamoxifen exposure and prior pelvic radiotherapy are risk factors, and the tumour often presents as a polypoid mass protruding through the cervix.
Surgery with hysterectomy, salpingo-oophorectomy, nodal assessment and omental sampling is followed by chemotherapy for almost every stage. Ifosfamide-paclitaxel had been the standard after GOG-0161, but GOG-0261 showed carboplatin-paclitaxel non-inferior and less toxic, and it is now the regimen of choice. Radiotherapy improves local control and is added for pelvic-confined disease with risk factors, and the ESGO/ESTRO/ESP guideline treats carcinosarcoma as p53-abnormal high-risk disease for adjuvant decisions. RUBY included carcinosarcoma among its histologies, so dostarlimab with chemotherapy is an option in advanced disease, with the largest benefit in the mismatch-repair-deficient minority.
HER2 is the most promising target. The Japanese STATICE trial gave trastuzumab deruxtecan to HER2-expressing carcinosarcoma and reported responses in about half of patients, and DESTINY-PanTumor02 included carcinosarcoma in its endometrial cohort, which underpins the tumour-agnostic approval for HER2 3+ tumours. Trials of WEE1 and ATR inhibitors exploit the p53-null cell cycle, and PARP inhibition is being tested on the same homologous recombination logic as in ovarian cancer. Rarity keeps carcinosarcoma out of most dedicated randomised trials, so its evidence base is borrowed from serous endometrial cancer.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Most high-grade ovarian cancers begin at the tip of the fallopian tube; endometrial cancer lines the uterus, cervical cancer starts at the transformation zone; each drains to a different node group.
Same organ: Adenosquamous carcinoma of the cervix, Small cell neuroendocrine carcinoma of the cervix, Bartholin gland carcinoma, Vulvar melanoma, Vaginal melanoma, High-grade serous ovarian cancer, Low-grade serous ovarian cancer, Clear cell ovarian cancer, Mucinous ovarian cancer, Adult granulosa cell tumour of the ovary, Ovarian cancer, Endometrial cancer, Cervical cancer, Vulvar cancer, Gestational trophoblastic neoplasia, Uterine sarcoma, Vaginal cancer, POLE-ultramutated endometrial cancer, Mismatch-repair-deficient endometrial cancer, p53-abnormal endometrial cancer, including uterine serous carcinoma, Endometrial cancer with no specific molecular profile, Advanced or recurrent endometrial cancer, Early cervical cancer and fertility-sparing surgery, Locally advanced cervical cancer, Recurrent or metastatic cervical cancer, Platinum-sensitive ovarian cancer, Platinum-resistant ovarian cancer, HPV-associated vulvar squamous cell carcinoma, HPV-independent vulvar squamous cell carcinoma (p53-mutant), Vaginal squamous cell carcinoma (HPV-associated), Vaginal adenocarcinoma (including DES-associated clear cell adenocarcinoma), Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk), Placental-site trophoblastic tumour and epithelioid trophoblastic tumour
Hysterectomy with bilateral salpingo-oophorectomy, sentinel node mapping or lymphadenectomy, and omental sampling.
Carboplatin-paclitaxel (GOG-0261), with pelvic radiotherapy and vaginal brachytherapy for stage I to III disease with risk factors; ifosfamide-paclitaxel is the older alternative.
Carboplatin-paclitaxel with dostarlimab (RUBY included carcinosarcoma); trastuzumab deruxtecan for HER2-expressing disease; lenvatinib-pembrolizumab after platinum.
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HER2 immunohistochemistry is now worth doing in advanced gynaecological and other cancers, since trastuzumab deruxtecan is approved for HER2 3+ solid tumours after prior therapy.
Women with newly diagnosed advanced or recurrent endometrial cancer should receive a PD-1 antibody (dostarlimab or pembrolizumab) with their chemotherapy, and mismatch repair testing is now essential because women with dMMR tumours gain a very large and durable benefit. The gain in mismatch-repair-proficient tumours is real but smaller, and molecular classification (POLE, p53, MMR) is increasingly used to decide who benefits most.
Carboplatin-paclitaxel is the chemotherapy standard for uterine carcinosarcoma in all stages, now combined with dostarlimab in advanced disease following RUBY, which included carcinosarcoma.
Query for this cancer: (TITLE:"Uterine carcinosarcoma" OR ABSTRACT:"Uterine carcinosarcoma" OR TITLE:"Malignant mixed Mullerian tumour" OR ABSTRACT:"Malignant mixed Mullerian tumour" OR TITLE:"MMMT" OR ABSTRACT:"MMMT" OR TITLE:"Endometrial carcinosarcoma" OR ABSTRACT:"Endometrial carcinosarcoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Uterine carcinosarcoma, not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
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Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
Any new or worsening cough, breathlessness or fever. The label says to interrupt treatment for any suspected ILD and to permanently discontinue for grade 2 or higher.
Temperature of 38 C or higher, or feeling shivery and unwell even without a fever. Antibody-drug conjugates suppress the bone marrow, and several carry a boxed warning for severe neutropenia.
See all on the product pages:CarboplatinDostarlimabIfosfamideLenvatinibPaclitaxel / nab-paclitaxelPembrolizumabTrastuzumab deruxtecan·Printable cards in the navigator
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