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e15523 Background: Metastatic or recurrent uterine leiomyosarcoma is often treated with chemotherapy. There are a limited number of viable regimens that are effective and well tolerated. Our objective was to evaluate the efficacy and toxicity of the MAID chemotherapy regimen in women with advanced uterine leiomyosarcoma. Methods: We conducted a retrospective analysis of 18 patients who received MAID chemotherapy for metastatic or recurrent uterine leiomyosarcoma between 1998 and 2010. Ten patients had received prior radiation therapy (3) and/or gemcitabine-docetaxel chemotherapy (8). The MAID regimen was administered intravenously in the hospital every three weeks as follows: mesna 120 mg/m2 prior to ifosfamide day 1 and 1.2 mg/m2 infusion over 8 hours starting immediately after the ifosfamide d 1-3, doxorubicin 15 mg/m2 d 1-3, ifosfamide 1.2 gm/m2 d 1-3, and dacarbazine 200 mg/m2 d 1-3. Disease response was evaluated by physical exam and imaging studies. Toxicity was assessed using NCI Common Toxicity Criteria. Results: Response to MAID chemotherapy was observed in 7 (39%) of 18 patients: 2 (11%) complete responses and 5 (28%) partial responses. Stable disease was noted in 8 patients (44%) and disease progression occurred in 3 patients (17%). There was no difference in response rates between patients who had received prior chemotherapy (3/8, 38%) and patients who had not received prior chemotherapy (4/10, 40%). A total of 90 cycles of chemotherapy were administered with a median of 5.5 (range 1-9) cycles per patient. Grades 3 and 4 toxicity requiring dose reduction of treatment delay complicated only 4 cycles (4.4%), including only one admission for neutropenic fever. There were no reported cases of cardiac dysfunction, hemorrhagic cystitis, or encephalopathy. The median progression-free survival was 10 (range 6-152) months for responders, 7.5 (range 3-120) months for those with stable disease, and 0 months for those with progressive disease. Conclusions: This is the largest series of uterine leiomyosarcoma patients treated with MAID chemotherapy. MAID chemotherapy in the dosage schedule utilized is a well-tolerated and effective regimen.