In a nutshell
The authors reviewed treatment options for melanomas of the gynecological tract (female reproductive systems).
Some background
Melanomas of the gynecological tract (vagina, vulva, ovary and cervix) are very rare cancers that occur in tissues called mucous membranes. They are fast-growing cancers that usually occur in post-menopausal women aged 50 to 70 years.
These mucosal melanomas are distinct from other types of skin cancer and require different treatment approaches. Surgery remains the current treatment of choice. Radiotherapy and chemotherapy are other treatment options but they have limited success in most patients. A better understanding of the different treatment approaches and new treatments is needed.
Methods & findings
In this article the authors summarized the treatment options for melanomas of the gynecological tract.
Surgery
Vulvar melanoma (cancer of the external part of female genital organs) is the most common gynecological melanoma. In the past surgery involved complete removal of the vulva. However, current treatment aims to only remove the tumor as this does not reduce patient survival. Between 8% and 55% of patients were still alive 5 years after treatment for vulvar melanoma.
The overall rate of survival for vaginal melanoma was 5-20%. The survival rate was associated with the size of the tumor. One study reported an average survival time of 12 months when the tumor was bigger than 3 cm, compared to 41 months when the tumor was smaller than 3 cm.
Melanoma of the uterine cervix indicates that there is cancer in the lower part of the uterus. Surgical removal of the uterus, cervix and part of vagina was usually the standard treatment for melanoma of the cervix.
Radiation
One report assessed the survival rates of 23 patients treated with radiation therapy for melanomas of the vagina, vulva or cervix. The survival rate after radiation was similar to the survival rate after surgery. Combining radiotherapy with drugs that stimulate the immune system (such as ipilimumab [Yervoy]) might further improve patient survival.
Recent advances in treatment
Increased numbers of mutations (permanent change) in a gene called KIT exist in melanomas of the gynecological tract. KIT is thought to be an important protein involved in cell growth and survival. Vulvar melanoma had more KIT mutations (18 to 35% of tumors) than other types of gynecological melanoma. Treatment with imatanib (Gleevec, a drug that blocks KIT) has shown promising results in patients with KIT mutations. Clinical trials are still ongoing.
The bottom line
The authors concluded that surgery remains the treatment of choice for melanomas of the gynecological tract. They also indicated that imatinib could be a promising treatment.
Published By :
Current opinion in oncology
Date :
Sep 01, 2014
