Uterine carcinosarcoma
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.
Overview
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.
State of the art
- Genomics reclassified carcinosarcoma from sarcoma to a metaplastic carcinoma, so it follows endometrial cancer guidelines.
- GOG-0261 replaced ifosfamide-paclitaxel with carboplatin-paclitaxel.
- HER2-directed antibody-drug conjugates are the first targeted therapy to show activity.
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowBleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
- Emergency services nowHypophysitis or adrenal crisis
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
- Emergency services nowBowel perforation
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
- Emergency services nowFainting or palpitations
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
- Emergency services nowSkin reaction
Blisters, peeling, or sores in the mouth or eyes with a rash. Enfortumab vedotin carries a boxed warning for Stevens-Johnson syndrome and toxic epidermal necrolysis, mostly in the first cycle.
- Call the 24-hour line nowInterstitial lung disease or pneumonitis
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.
See all on the product pages:CarboplatinDostarlimabIfosfamideLenvatinibPaclitaxel / nab-paclitaxelPembrolizumabTrastuzumab deruxtecan·Printable cards in the navigator
Anatomy and lymph node drainage
- Fallopian tube fimbria (origin of high-grade serous)
- Ovary (other histologies, germ cell)
- Endometrium
- Myometrium (uterine sarcoma)
- Placental site (gestational trophoblastic)
- Cervix, transformation zone
- Vulva
- Nodes: obturator and external iliac
- Nodes: internal iliac
- Nodes: para-aortic (ovary, high uterus)
- Nodes: inguinal (vulva)
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.
- Fallopian tube fimbria (origin of high-grade serous)Serous-type carcinoma component (most common, p53-abnormal)
- Ovary (other histologies, germ cell)
- EndometriumHomologous carcinosarcoma (sarcoma element resembles uterine tissue) · Heterologous carcinosarcoma (cartilage, bone or skeletal muscle elements) · Serous-type carcinoma component (most common, p53-abnormal) · HER2-expressing carcinosarcoma (trastuzumab deruxtecan) · Mismatch-repair-deficient carcinosarcoma (minority, immunotherapy-responsive) · Stage I carcinosarcoma (adjuvant chemotherapy with or without radiotherapy)
- Myometrium (uterine sarcoma)Homologous carcinosarcoma (sarcoma element resembles uterine tissue) · Heterologous carcinosarcoma (cartilage, bone or skeletal muscle elements) · HER2-expressing carcinosarcoma (trastuzumab deruxtecan) · Mismatch-repair-deficient carcinosarcoma (minority, immunotherapy-responsive) · Stage I carcinosarcoma (adjuvant chemotherapy with or without radiotherapy)
- Placental site (gestational trophoblastic)
- Cervix, transformation zone
- Vulva
- obturator and external iliac
- internal iliac
- para-aortic (ovary, high uterus)
- inguinal (vulva)
Same organ: 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
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- About five percent of uterine cancers but a far larger share of deaths; most patients are older women, half present with disease beyond the uterus, and even stage I tumours recur in a third of cases.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
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.
Subtypes & biomarkers
top- Homologous carcinosarcoma (sarcoma element resembles uterine tissue)
- Heterologous carcinosarcoma (cartilage, bone or skeletal muscle elements)
- Serous-type carcinoma component (most common, p53-abnormal)
- HER2-expressing carcinosarcoma (trastuzumab deruxtecan)
- Mismatch-repair-deficient carcinosarcoma (minority, immunotherapy-responsive)
- Stage I carcinosarcoma (adjuvant chemotherapy with or without radiotherapy)
- p53 immunohistochemistry (abnormal in most)
- HER2 immunohistochemistry and in situ hybridisation
- MMR immunohistochemistry (deficient in a minority)
- POLE (rare, favourable)
- Percentage of sarcomatous component and heterologous elements
- CA-125
How often this target appears
- 2007GOG-0161: ifosfamide-paclitaxel improves survival over ifosfamide alone
- 2014WHO classifies carcinosarcoma as a metaplastic carcinoma rather than a sarcoma
- 2017TCGA sequencing confirms a shared clonal origin of both components with frequent TP53 mutation
- 2022GOG-0261: carboplatin-paclitaxel non-inferior to ifosfamide-paclitaxel
- 2023STATICE: trastuzumab deruxtecan active in HER2-expressing carcinosarcoma
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 9 changes by month →- 2026-09-17This recordUterine carcinosarcomaFacts on this page last checked
When this page itself was last checked or edited.
- 2023Trial resultDESTINY-PanTumor02DESTINY-PanTumor02 reported
Endometrial ORR 57.
- 2023Trial resultRUBY / ENGOT-EN6 / GOG-3031RUBY / ENGOT-EN6 / GOG-3031 reported
OS 44.
- 2023MilestoneTrastuzumab deruxtecanSTATICE: trastuzumab deruxtecan active in HER2-expressing carcinosarcoma
A milestone in how this cancer is treated.
- 2022MilestoneCarboplatinGOG-0261: carboplatin-paclitaxel non-inferior to ifosfamide-paclitaxel
A milestone in how this cancer is treated.
- 2018Trial resultPORTEC-3PORTEC-3 reported
5-year OS 81.
What is in development for Uterine carcinosarcoma, drawn from the whole corpus: 5 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Trials reported · 2
- DESTINY-PanTumor02 · phase 2 · 2023 · positive
- RUBY / ENGOT-EN6 / GOG-3031 · phase 3 · 2023 · positive
Targets under investigation · 2
Ideas not yet in a trial · 1
Open problems and what is being done
No dedicated randomised trials for a tumour that behaves worse than the serous cancers it is grouped with.
Whether the sarcomatous component needs different drugs.
High relapse rate after apparently complete treatment of stage I disease.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
New York · cancer center | United States | 0 | 5,100 | 94,456 | #1 | ||
Villejuif · cancer center | France | none recorded | 0 | 1,855 | 31,182 | #6 | |
Baltimore · cancer center | United States | 0 | 2,955 | 41,449 | #10 | ||
Milan · cancer center | Italy | none recorded | 0 | 1,246 | 21,746 | #11 | |
Tokyo · government | Japan | none recorded | 0 | 1,599 | 21,937 | none recorded | #13 |
Seoul · hospital | South Korea | none recorded | 0 | 464 | 3,248 | #22 | |
Philadelphia, PA · consortium | United States | none recorded | 1 | 165 | 1,237 | - | |
Newcastle, NSW · consortium | Australia | none recorded | 1 | 34 | 760 | - | |
Chicago, IL · consortium | United States | none recorded | 1 | not matched | - | - | |
Shanghai · hospital | China | none recorded | 0 | 2,872 | 31,534 | - | |
Sydney · cancer center | Australia | none recorded | 0 | 2,222 | 33,278 | - | |
Los Angeles · cancer center | United States | 0 | 2,019 | 32,934 | - | ||
Beijing · hospital | China | none recorded | 0 | 1,784 | 18,230 | - | |
Utrecht · cancer center | Netherlands | none recorded | 0 | 1,422 | 20,323 | - | |
Beijing · cancer center | China | none recorded | 0 | 1,344 | 18,195 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Uterine carcinosarcoma but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Uterine carcinosarcoma
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example p53 immunohistochemistry, HER2 immunohistochemistry and in situ hybridisation, MMR immunohistochemistry, POLE, Percentage of sarcomatous component and heterologous elements), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Homologous carcinosarcoma, Heterologous carcinosarcoma, Serous-type carcinoma component.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Surgery
- For my situation (surgery), which of the standard options do you recommend and why?Why: Guideline options include: Hysterectomy with bilateral salpingo-oophorectomy, sentinel node mapping or lymphadenectomy, and omental sampling.
Adjuvant, all stages
- For my situation (adjuvant, all stages), which of the standard options do you recommend and why?Why: Guideline options include: 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.
- Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, Ifosfamide, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of PORTEC-3 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Advanced or recurrent
- For my situation (advanced or recurrent), which of the standard options do you recommend and why?Why: Guideline options include: Carboplatin-paclitaxel with dostarlimab (RUBY included carcinosarcoma); trastuzumab deruxtecan for HER2-expressing disease; lenvatinib-pembrolizumab after platinum.
- Am I a candidate for Dostarlimab, Trastuzumab deruxtecan, Lenvatinib or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of RUBY / ENGOT-EN6 / GOG-3031 and DESTINY-PanTumor02 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of Trastuzumab deruxtecan, Dostarlimab, WEE1, ATR?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “No dedicated randomised trials for a tumour that behaves worse than the serous cancers it is grouped with”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Whether the sarcomatous component needs different drugs”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Uterine carcinosarcoma, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
11targets
9drugs
7companies
6terms
1trials
3ideas
1Latest papers
topQuery 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.
Similar pages
not linked directly; found by shared links- Cancerp53-abnormal endometrial cancer, including uterine serous carcinoma
Shares HER2 ADCs as standard for HER2-positive serous endometrial cancer, Hysterectomy, DESTINY-PanTumor02, PORTEC-3 and the tag subtype-page.
- CancerPOLE-ultramutated endometrial cancer
Shares Hysterectomy, PORTEC-3, Dostarlimab, Sentinel lymph node biopsy and the tag subtype-page.
- CancerEndometrial cancer with no specific molecular profile
Shares Hysterectomy, PORTEC-3, RUBY / ENGOT-EN6 / GOG-3031, Dostarlimab and the tag subtype-page.
- CancerMismatch-repair-deficient endometrial cancer
Shares Hysterectomy, PORTEC-3, RUBY / ENGOT-EN6 / GOG-3031, Dostarlimab and the tag subtype-page.
- CancerAdvanced or recurrent endometrial cancer
Shares DESTINY-PanTumor02, RUBY / ENGOT-EN6 / GOG-3031, Dostarlimab, Lenvatinib and the tag subtype-page.
- CancerRecurrent or metastatic cervical cancer
Shares DESTINY-PanTumor02, Robotic & minimally invasive surgery, Trastuzumab deruxtecan, HER2 and the tag subtype-page.
- CancerEarly cervical cancer and fertility-sparing surgery
Shares Hysterectomy, Sentinel lymph node biopsy, Brachytherapy, Robotic & minimally invasive surgery and the tag subtype-page.
- CancerLocally advanced cervical cancer
Shares Brachytherapy, Robotic & minimally invasive surgery, Paclitaxel / nab-paclitaxel, Carboplatin and the tag subtype-page.