The Future of Targeted Therapy for Leiomyosarcoma

Simple Summary Leiomyosarcoma is a subtype of soft tissue sarcoma with poor outcomes and response to currently available treatments. The goal of this review is to assess the current landscape of targeted therapies and explore how our current understanding of the biology of leiomyosarcoma may inform the development of new targeted therapies to improve the treatment of leiomyosarcoma.Abstract Leiomyosarcoma (LMS) is an aggressive subtype of soft tissue sarcoma that arises from smooth muscle cells, most commonly in the uterus and retroperitoneum. LMS is a heterogeneous disease with diverse clinical and molecular characteristics that have yet to be fully understood. Molecular profiling has uncovered possible targets amenable to treatment, though this has yet to translate into approved targeted therapies in LMS. This review will explore historic and recent findings from molecular profiling, highlight promising avenues of current investigation, and suggest possible future strategies to move toward the goal of molecularly matched treatment of LMS. We focus on targeting the DNA damage response, the macrophage-rich micro-environment, the PI3K/mTOR pathway, epigenetic regulators, and telomere biology.