Chemotherapy Before Surgery Improves Treatment of Sarcoma

For patients with localized soft-tissue sarcoma of the trunk or extremities who are high risk for relapse, the use of anthracycline plus ifosfamide chemotherapy prior to surgery appears to improve survival. Chemotherapy administered before surgery is called neoadjuvant therapy and has not previously been demonstrated to improve outcomes in soft tissue sarcoma (STS).

Soft tissue sarcomas are a type of cancer originating in the soft tissues that connect, support and surround other body structures, such as muscle, fat, blood vessels, nerves, tendons and the lining of joints. In the U.S., about 12,000 people will be diagnosed and approximately 4,990 are expected to die of soft tissue sarcomas in 2016. There are several types of soft tissue sarcomas making it very hard to diagnose and difficult to treat. Until recently there have been no significant advances for the treatment of STS that have improved overall survival.

The results of a recently reported clinical study suggest that chemotherapy administered before surgical removal of a sarcoma may improve patient outcomes.1

Between May 2011 and May 2016, 435 patients with localized high-risk STS of the extremities or trunk from 32 sites in four countries were randomly assigned to receive treatment with epirubicin plus ifosfamide chemotherapy or one of the following chemotherapy regimens thought to work in specific STS subtypes:

  • gemcitabine plus docetaxel for undifferentiated pleomorphic sarcoma (n = 97);
  • trabectedin for high-grade myxoid liposarcoma (n = 65);
  • high-dose prolonged-infusion ifosfamide for synovial sarcoma (n = 70);
  • etoposide plus ifosfamide for malignant peripheral nerve sheath tumors (n = 27); and
  • gemcitabine plus dacarbazine for leiomyosarcoma (n = 28).

Patients have now been followed for an average of just over one year and the study appears to demonstrate that the epirubicin plus ifosfamide chemotherapy regimen improves survival and delays time to cancer recurrence.

Surgery remains the standard treatment for all patients with resectable STS, however many patients will experience a sarcoma recurrence following treatment with surgery alone. Although clinical studies have previously evaluated using radiation and/or chemotherapy before or after surgery in order to decrease the risk of recurrence, this is the first time that convincing evidence favoring the use of chemotherapy before surgery has been demonstrated.

For the first time in many years new drugs have been approved for the treatment of sarcoma offering new hope to individuals diagnosed with this cancer.2,3 These newer more effective drugs will be evaluated in the neoadjuvant setting in order to determine if additional improvement in the management of STS can be attained.

References:

  1. European Society for Medical Oncology (ESMO) Congress. Abstract LBA6_PR. Presented October 10, 2016.
  2. Demetri G, von Mehren M, Jones R, et al. Efficacy and Safety of Trabectedin or Dacarbazine for Metastatic Liposarcoma or Leiomyosarcoma After Failure of Conventional Chemotherapy: Results of a Phase III Randomized Multicenter Clinical Trial. Journal of Clinical Oncology. Published online before print September 14, 2015, doi: 10.1200/JCO.2015.62.4734.
  3. United States Food and Drug Administration. FDA approves first drug to show survival benefit in liposarcoma. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm483714.htm. Accessed January 28, 2016.

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