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Tian Z, Yao W. Chemotherapeutic drugs for soft tissue sarcomas: a review. Front Pharmacol 2023; 14:1199292. [PMID: 37637411 PMCID: PMC10450752 DOI: 10.3389/fphar.2023.1199292] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/03/2023] [Indexed: 08/29/2023] Open
Abstract
Despite the low incidence of soft tissue sarcomas (STSs), hundreds of thousands of new STS cases are diagnosed annually worldwide, and approximately half of them eventually progress to advanced stages. Currently, chemotherapy is the first-line treatment for advanced STSs. There are difficulties in selecting appropriate drugs for multiline chemotherapy, or for combination treatment of different STS histological subtypes. In this study, we first comprehensively reviewed the efficacy of various chemotherapeutic drugs in the treatment of STSs, and then described the current status of sensitive drugs for different STS subtypes. anthracyclines are the most important systemic treatment for advanced STSs. Ifosfamide, trabectedin, gemcitabine, taxanes, dacarbazine, and eribulin exhibit certain activities in STSs. Vinca alkaloid agents (vindesine, vinblastine, vinorelbine, vincristine) have important therapeutic effects in specific STS subtypes, such as rhabdomyosarcoma and Ewing sarcoma family tumors, whereas their activity in other subtypes is weak. Other chemotherapeutic drugs (methotrexate, cisplatin, etoposide, pemetrexed) have weak efficacy in STSs and are rarely used. It is necessary to select specific second- or above-line chemotherapeutic drugs depending on the histological subtype. This review aims to provide a reference for the selection of chemotherapeutic drugs for multi-line therapy for patients with advanced STSs who have an increasingly long survival.
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Affiliation(s)
| | - Weitao Yao
- Department of Orthopedics, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
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Emambux S, Italiano A. Clinical efficacy of eribulin mesylate for the treatment of metastatic soft tissue sarcoma. Expert Opin Pharmacother 2017; 18:819-824. [PMID: 28468516 DOI: 10.1080/14656566.2017.1326908] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Metastatic soft tissue sarcoma, a devastating disease, has a median overall survival of only 12-18 months. Treatment options remain scarce. However, eribulin mesylate, a first-in-class halichondrin B-based microtubule dynamics inhibitor, has recently been approved for the management of patients with advanced liposarcoma. Areas covered: Based on a review of the literature between 2005 and 2017, we present a summary of eribulin mesylate's mechanism of action and the studies showing its clinical efficacy in locally advanced or metastatic sarcomas. Expert commentary: Future development includes the definition of a biomarker signature related to patient outcome with eribulin. Further investigation via controlled clinical trials is needed to identify combination regimens that can optimize the efficacy of eribulin while providing an acceptable safety profile in sarcoma patients.
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Affiliation(s)
- Sheik Emambux
- a Early Phase Trials and Sarcoma Units , Institut Bergonié , Bordeaux , France
| | - Antoine Italiano
- a Early Phase Trials and Sarcoma Units , Institut Bergonié , Bordeaux , France
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Multimodal treatment with doxorubicin, cisplatin, and ifosfamide for the treatment of advanced or metastatic uterine leiomyosarcoma: a unicentric experience. Int J Gynecol Cancer 2015; 25:296-302. [PMID: 25581897 DOI: 10.1097/igc.0000000000000344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Uterine leiomyosarcoma (ULMS) is a rare gynecologic malignancy characterized by a poor prognosis due to a high rate of local and metastatic recurrences. Chemotherapy with doxorubicin or ifosfamide or both is associated with a 10% to 30% objective response rate. We report a monocentric experience with doxorubicin, cisplatin, and ifosfamide (API) combination in the setting of multimodal treatment of advanced or metastatic ULMS. PATIENTS AND METHODS This monocentric retrospective study included patients with metastatic or locally advanced ULMS with a physiological age younger than 65 years treated in first line with a multimodal aggressive approach with API chemotherapy. Treatment consisted of doxorubicin 50 mg/m2 d1, ifosfamide 3 g/m2 per day d1d2 plus mesna, cisplatin 75 mg/m2 d3, plus G-CSF; every 3 weeks up to 6 cycles. Surgery, radiation therapy, or radiofrequency ablation therapy of metastatic sites was associated whenever possible. RESULTS Thirty-eight patients received API for metastatic or locally advanced ULMS. Median age was 51 years (40-64 years); 4 (11%) patients were treated for a locally advanced disease and 34 (89%) for metastatic disease. Sixteen patients responded (4 complete responses+12 partial responses) among 33 evaluable patients (objective response rate, 48%); 8 and 9 patients had, respectively, stable and progressive disease. Twelve patients had surgeries with 9 surgical complete responses and 3 surgical partial responses. Median progression-free and overall survival in the whole population were 9.8 and 27 months, respectively. Main grade 3-4 toxicities in 38 patients were neutropenia (74%), thrombocytopenia (60%), anemia (55%), fatigue (18%), and vomiting (13%). Febrile neutropenia was observed in 37% of patients. CONCLUSIONS Despite the toxicity observed, API is an effective treatment which compares favorably with other first-line therapies for patients with metastatic or advanced ULMS.
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Arifi S, Belbaraka R, Rahhali R, Ismaili N. Treatment of Adult Soft Tissue Sarcomas: An Overview. RARE CANCERS AND THERAPY 2015; 3:69-87. [PMID: 27182479 PMCID: PMC4837937 DOI: 10.1007/s40487-015-0011-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Indexed: 01/08/2023]
Abstract
Sarcomas are uncommon malignancies accounting for about 1% of all adult malignancies. Sarcomas are a heterogeneous group of tumors which includes more than 100 different subtypes. Surgery is the mainstay therapy for localized disease. In selected patients the combination of surgery with radiotherapy achieves better local control and offers the best chance of cure. Systemic treatment including cytotoxic chemotherapy or targeted therapies remains the mainstay therapy for most patients with advanced disease. There are a wide variety of clinical situations, such that an individualized treatment plan must be defined by a multidisciplinary tumor board. Treatment decisions should take into consideration the histology, site of disease, stage, performance status, treatment goals, and the patient's wishes. The management of patients should be carried out in a center with expertise in the treatment of sarcomas for optimal outcome. This review will cover the different treatment modalities of adult soft tissue sarcomas.
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Affiliation(s)
- Samia Arifi
- Department of Medical Oncology, Hassan II University Hospital, Medical School, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Rhizlan Belbaraka
- Department of Medical Oncology, Mohammed VI University Hospital, Marrakech, Morocco
| | - Rabie Rahhali
- Department of Medical Oncology, Regional Center of Oncology, Tangier, Morocco
| | - Nabil Ismaili
- Department of Medical Oncology, Mohammed VI University Hospital, Marrakech, Morocco
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Schöffski P, Cornillie J, Wozniak A, Li H, Hompes D. Soft tissue sarcoma: an update on systemic treatment options for patients with advanced disease. Oncol Res Treat 2014; 37:355-62. [PMID: 24903768 DOI: 10.1159/000362631] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/07/2014] [Indexed: 11/19/2022]
Abstract
Sarcomas are a group of rare solid tumours arising from mesenchymal or connective tissue. This review focuses on soft tissue sarcoma and covers general topics such as the epidemiology, age distribution, site of disease, histogenesis, histological subtypes, prognosis and outcome of treatment. In more detail, the article reviews current systemic treatment standards and selected adverse events of agents such as doxorubicin, ifosfamide, trabectedin and pazopanib, and briefly highlights some drugs that are used off-label in specific subtypes of sarcoma.
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Affiliation(s)
- Patrick Schöffski
- Department of General Medical Oncology and Laboratory of Experimental Oncology, Leuven Cancer Institute, KU Leuven, Belgium
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Santoro A, Romanini A, Rosso A, Frustaci S, Comandone A, Apice G, De Toma D, Dogliotti L, Lionetto R, Dani C, Bruzzi P, Piolini M, Bergnolo P, Verusio C. Lack of Activity of Docetaxel in Soft Tissue Sarcomas: Results of a Phase II Study of the Italian Group on Rare Tumors. Sarcoma 2011; 3:177-81. [PMID: 18521282 PMCID: PMC2395431 DOI: 10.1080/13577149977613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose. The prognosis of advanced soft tissue sarcoma is poor, only
a few drugs showing some activity with response rates around 15– 25%. Consequently drug
development seems mandatory to improve treatment outcome. Following previous
favourable EORTC experience, the Italian Group on Rare Tumors started a phase II study
with docetaxel to confirm the activity of this drug in soft tissue sarcoma. Patients and methods. Thirty-seven patients with soft tissue sarcoma
resistant to at least one anthracyclinecontaining regimen were enrolled in a phase II multicenter
study evaluating docetaxel 100 mg/m2
in a 1-h i.v. infusion q3
weeks. Results.Thirty-seven patients were enrolled onto this phase II study and
36 were evaluable for response. Only one partial remission was observed [2.8% with 95%
confidence interval (CI) 0.1– 16.2%]. Median progression-free and overall survival
were 42 and 350 days, respectively. Neutropenia and leukopenia as well as cutaneous
manifestations were the most common toxicities. Discussion. The results of this phase II study do not confirm a previous
EORTC repor t on the activity of docetaxel in soft tissue sarcoma, but are consistent with
other more recent phase II studies. The accumulated evidence does not justify the use of this
drug in the management of patients suffering from this disease, resistant to
anthracyclinecontaining regimens.
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Affiliation(s)
- A Santoro
- Italian Group on Rare Tumors c/o Istituto Clinico Humanitas Via Manzoni, 56 Milano Rozzano 20089 Italy
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Miller BE, Blessing JA, Stehman FB, Shahin MS, Yamada SD, Secord AA, Warshal DP, Abulafia O, Richards WE, Van Le L. A phase II evaluation of weekly gemcitabine and docetaxel for second-line treatment of recurrent carcinosarcoma of the uterus: A gynecologic oncology group study. Gynecol Oncol 2010; 118:139-44. [DOI: 10.1016/j.ygyno.2010.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 03/30/2010] [Accepted: 03/31/2010] [Indexed: 10/19/2022]
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Kalofonos HP, Kourousis C, Karamouzis MV, Iconomou G, Tsiata E, Tzorzidis F, Megas P, Lambiris E, Georgoulias V. A Phase II Study of Docetaxel and Epirubicin in Advanced Adult Soft Tissue Sarcomas (STS). Sarcoma 2008; 8:129-33. [PMID: 18521407 PMCID: PMC2395619 DOI: 10.1080/13577140400016705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: The aim of this study was to determine the efficacy and safety of docetaxel plus epirubicin combination as first-line
chemotherapy in patients with locally advanced and/or metastatic adult STS. Patients and Methods: Eighteen patients were treated with epirubicin 30 mg/m2 on days 1 to 3 and docetaxel 100 mg/m2 on
day 1 every 3 weeks. Results: Fifteen out of 18 patients (83.4%) were assessable for response. No complete response was recorded. Three (20%)
patients achieved PR, 3 had SD and 9 PD. The overall median survival was 14 months (range, 3–48 months) and the median
time to disease progression was 4 months (range, 2–45 months). Grade ≥ 3 neutropenia occurred in 88% and neutropenic
fever in 27.8% of patients. Other toxicities were mild. No treatment related deaths occurred. Discussion: Docetaxel plus epirubicin combination achieved low response rate with severe myelotoxicity in patients with
advanced STS.
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Affiliation(s)
- Haralabos P Kalofonos
- Division of Oncology Department of Medicine University Hospital Patras Medical School Rion 26504 Greece
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Verweij J, Lee SM, Ruka W, Buesa J, Coleman R, van Hoessel R, Seynaeve C, di Paola ED, van Glabbeke M, Tonelli D, Judson IR. Randomized phase II study of docetaxel versus doxorubicin in first- and second-line chemotherapy for locally advanced or metastatic soft tissue sarcomas in adults: a study of the european organization for research and treatment of cancer soft tissue and bone sarcoma group. J Clin Oncol 2000; 18:2081-6. [PMID: 10811673 DOI: 10.1200/jco.2000.18.10.2081] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess antitumor response and time to progression (TTP) with docetaxel compared with doxorubicin in first-line treatment of advanced and/or metastatic soft tissue sarcoma. PATIENTS AND METHODS Patients with measurable soft tissue sarcoma lesions and adequate bone marrow, liver, and renal function were entered onto the study. They were randomized to either docetaxel 100 mg/m(2) given as a 1-hour intravenous infusion every 3 weeks or doxorubicin 75 mg/m(2) given as a bolus injection every 3 weeks. A maximum of seven cycles of treatment were scheduled. The study was designed as a randomized phase III study evaluating TTP by log-rank model. There was a clause for premature closure of the trial if fewer than five responses were observed among the first 25 assessable patients in the docetaxel treatment arm. RESULTS Eighty-six patients were entered onto the study; 85 were assessable for toxicity and 83 for response. The rate of severe granulocytopenia was not significantly different between the two arms. Nausea (P =.001), vomiting (P <.001), and stomatitis (P =.005) were more common with doxorubicin therapy, whereas neurotoxicity was more frequent with docetaxel treatment. The response rate to doxorubicin therapy was 30% (95% confidence interval, 17% to 46%), whereas no responses to docetaxel therapy were seen (P <.001). In view of this, the trial was closed prematurely and the phase III study part was not conducted. CONCLUSION Docetaxel is inactive in soft tissue sarcomas and cannot be recommended for further use in treatment of this disease.
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Affiliation(s)
- J Verweij
- Department of Medical Oncology, Rotterdam Cancer Institute, and University Hospital Rotterdam, Nijmegen, the Netherlands
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Abstract
This article reviews the current standard approaches to the treatment of metastatic soft tissue sarcoma (STS) and evaluates new chemotherapy agents and novel approaches. A computerized search strategy was used to identify articles examining the role of chemotherapy and surgery in metastatic STS, which were published between January 1992 and December 1998. This search was supplemented by key articles from our files published before 1992. In selecting articles for inclusion in this review, emphasis was placed on randomized data and novel approaches. Only three agents-doxorubicin, ifosfamide, and dacarbazine-have shown significant activity in metastatic STS. Numerous studies have examined the efficacy and toxicity of combining the known active agents in standard doses or in high doses with cytokine support. Promising results, in terms of increased response rates, often have not been reproduced in randomized trials, and there is no convincing evidence of enhanced overall survival. New regimens should be evaluated in randomized trials incorporating quality-of-life endpoints. High-dose chemotherapy with bone marrow/stem cell rescue remains an investigational procedure of uncertain efficacy. Pilot studies have established the feasibility of intraperitoneal chemotherapy, after cytoreductive surgery, in patients with peritoneal sarcomatosis. To date, the efficacy of this approach has not been validated in phase II or III trials. The role of surgery in the treatment of isolated pulmonary metastases is well established. Results of small series raise the possibility that resection of hepatic metastases is beneficial in selected patients. Current chemotherapy options for patients with STS are limited. There is reason to hope that the situation will change with the further development of new agents that have novel and specific mechanisms of action.
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Affiliation(s)
- M Sawyer
- Department of Medical Oncology, London Regional Cancer Centre, London, Ontario, Canada
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