Endometrial carcinosarcoma

Giorgio Bogani, Isabelle Ray-Coquard, Nicole Concin, Natalie Yan Li Ngoi, Philippe Morice, Giuseppe Caruso, Takayuki Enomoto, Kazuhiro Takehara, Hannelore Denys, Domenica Lorusso, Robert Coleman, Michelle M. Vaughan, Masashi Takano, Diane Michele Provencher, Satoru Sagae, Pauline Wimberger, Robert Póka, Yakir Segev, Se Ik Kim, Jae Weon KimFrancisco Jose Candido Dos Reis, Pedro T. Ramirez, Andrea Mariani, Mario Leitao, Vicky Makker, Nadeem R. Abu-Rustum, Ignace Vergote, Gianfranco Zannoni, David Tan, Mary McCormack, Biagio Paolini, Marta Bini, Francesco Raspagliesi, Pierluigi Benedetti Panici, Violante Di Donato, Ludovico Muzii, Nicoletta Colombo, Sandro Pignata, Giovanni Scambia, Bradley J. Monk

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


Endometrial carcinosarcoma is a rare and aggressive high-grade endometrial carcinoma with secondary sarcomatous trans-differentiation (conversion theory). The clinical presentation and diagnostic work-up roughly align with those of the more common endometrioid counterpart, although endometrial carcinosarcoma is more frequently diagnosed at an advanced stage. Endometrial carcinosarcoma is not a single entity but encompasses different histological subtypes, depending on the type of carcinomatous and sarcomatous elements. The majority of endometrial carcinosarcomas are characterized by p53 abnormalities. The proportion of POLE and microsatellite instablity-high (MSI-H) is directly related to the epithelial component, being approximately 25% and 3% in endometrioid and non-endometrioid components. The management of non-metastatic disease is based on a multimodal approach with optimal surgery followed by (concomitant or sequential) chemotherapy and radiotherapy, even for early stages. Palliative chemotherapy is recommended in the metastatic or recurrent setting, with carboplatin/paclitaxel doublet being the first-line regimen. Although the introduction of immunotherapy plus/minus a tyrosine kinase inhibitor shifted the paradigm of treatment of patients with recurrent endometrial cancer, patients with endometrial carcinosarcoma were excluded from most studies evaluating single-agent immunotherapy or the combination. However, the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) approved the use of pembrolizumab and lenvatinib in endometrial cancer (all histotypes) after progression on chemotherapy and single-agent immunotherapy in MSI-H cancers. In the era of precision medicine, emerging knowledge on molecular endometrial carcinosarcoma is opening new promising therapeutic options for more personalized treatment. The present review outlines state-of-the-art knowledge and future directions for patients with endometrial carcinosarcoma.

Original languageEnglish (US)
Pages (from-to)147-174
Number of pages28
JournalInternational Journal of Gynecological Cancer
Issue number2
StatePublished - Feb 6 2023


  • carcinosarcoma
  • genital neoplasms, female
  • uterine cancer
  • Carboplatin/therapeutic use
  • Uterine Neoplasms/pathology
  • Humans
  • Endometrial Neoplasms/therapy
  • Carcinosarcoma/therapy
  • Neoplasm Recurrence, Local
  • Female
  • Combined Modality Therapy

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology


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