Use of Rucaparib Plus Temozolomide in Advanced Uterine Leiomyosarcoma: A Case Report From a Tertiary Centre in India

The treatment landscape for metastatic uterine leiomyosarcoma has expanded in recent years with the introduction of newer chemotherapeutic and targeted therapies; however, effective treatment options remain limited. We present the case of a woman in her early 60s with metastatic uterine leiomyosarcoma who had received five lines of therapy for metastatic disease. She was subsequently treated with rucaparib 400 mg twice daily on days one through seven of a 28-day cycle and temozolomide 120 mg once daily on days one through seven of the same cycle, with subsequent dose reduction of both agents because of hematological toxicity. After three months of treatment, she achieved a complete metabolic response on fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT). After eight months of treatment, she developed progressive disease. Next-generation sequencing for the homologous recombination repair deficiency panel was attempted but was unsuccessful because of degraded DNA; therefore, her homologous recombination deficiency status could not be confirmed. This case describes clinical activity with rucaparib plus temozolomide in a heavily pretreated patient with advanced uterine leiomyosarcoma and highlights the need for further investigation of this therapeutic approach.