The Impact of O6-Methylguanine-DNA Methyltransferase (<i>MGMT</i>) Promoter Methylation on the Outcomes of Patients with Leiomyosarcoma Treated with Dacarbazine
Lucia Cannella,
Rosa Della Monica,
Antonella Lucia Marretta,
Domenico Iervolino,
Bruno Vincenzi,
Anna Rosaria De Chiara,
Ottavia Clemente,
Michela Buonaiuto,
Maria Luisa Barretta,
Annabella Di Mauro,
Massimiliano Di Marzo,
Michele Guida,
Giuseppe Badalamenti,
Lorenzo Chiariotti,
Salvatore Tafuto
Affiliations
Lucia Cannella
S.C. Sarcomi e Tumori Rari, Istituto Nazionale Tumori—IRCCS—Fondazione “G. Pascale”, 80131 Naples, Italy
Dacarbazine is an important drug in the therapeutic landscape of leiomyosarcoma (LMS). Alkylating agents are subjected to resistance mechanisms based on anti-apoptotic pathways and repair mechanisms, including the DNA repair enzyme O6-methylguanine-DNA methyltransferase (MGMT). In this retrospective study, the methylation status of the MGMT promoter in histological tumor samples from patients with LMS, dacarbazine-based regimens-treated, was measured and correlated with clinical outcomes aimed at optimizing the use of dacarbazine in soft tissue sarcomas. The patients with unmethylated MGMT had better outcomes than those with methylated MGMT. Patients without MGMT methylation had better Progression Free Survival (PFS) when aged ≥62 years compared to those aged MGMT was less favorable independently of age (p = 0.0054). The patients without a methylated MGMT gene had higher Disease control rate (DCR). These results are not in agreement with the role of the methylated MGMT gene in other tumors, and with this study, we demonstrated the correlation between methylated MGMT and poor prognosis; despite that, sample smallness, heterogeneity of LMS and of treatment history could be selection bias. Predictive markers of response to chemotherapies in sarcomas remain an unmet need.
