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Immunotherapy with nivolumab for the treatment of soft tissue sarcoma with pulmonary metastasis: A case report. Mol Clin Oncol 2020; 13:191-194. [PMID: 32714545 DOI: 10.3892/mco.2020.2067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/21/2019] [Indexed: 11/05/2022] Open
Abstract
Sarcomas are an unusual group of tumors, accounting for ~1% of cancer in adults. Immunotherapy has been shown to be a potential therapeutic option for the management of patients with cancer. However, there is still insufficient information on the action of immunotherapy on sarcomas. A 16-year-old male patient, diagnosed in December 2013 with grade III soft-tissue sarcoma in the right arm, was admitted to a private oncology service after relapse following surgical treatment. The patient underwent chemotherapy with ifosfamide plus adriamycin for 4 cycles, associated with adjuvant radiotherapy, followed by a new resection to remove the residual lesion. A year later, imaging tests identified pulmonary micronodules, and a new resection was performed. After immunohistochemical evaluation of biopsy, a large presence of programmed cell death 1 ligand 1 (PD-L1) marker was identified in tumor tissue and immunotherapy with nivolumab was performed. At present, the patient is in immunotherapeutic treatment (42 cycles), presenting an excellent general condition and without any symptoms, and a decrease in neoplastic lung masses. The literature recommends three cycles of anthracycline plus ifosfamide as adjuvant therapy to surgical treatment. Combined surgery plus adjuvant therapy has shown benefits in malignant tumors. Immunotherapy is an important therapeutic option for soft-tissue sarcomas with high programmed cell death protein 1 (PD-1)/PD-L1 expression. Treatment for high grade soft tissue sarcoma (STS) is still limited, due to tumor heterogeneity, and further studies are needed to consolidate the possibility of using immunotherapy to treat these neoplasms. When significant levels of specific biomarkers are present in tumor tissue, immunotherapy may be beneficial as shown by the present case report.
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Biernacki K, Daśko M, Ciupak O, Kubiński K, Rachon J, Demkowicz S. Novel 1,2,4-Oxadiazole Derivatives in Drug Discovery. Pharmaceuticals (Basel) 2020; 13:ph13060111. [PMID: 32485996 PMCID: PMC7345688 DOI: 10.3390/ph13060111] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022] Open
Abstract
Five-membered 1,2,4-oxadiazole heterocyclic ring has received considerable attentionbecause of its unique bioisosteric properties and an unusually wide spectrum of biological activities.Thus, it is a perfect framework for the novel drug development. After a century since the1,2,4-oxadiazole have been discovered, the uncommon potential attracted medicinal chemists'attention, leading to the discovery of a few presently accessible drugs containing 1,2,4-oxadiazoleunit. It is worth noting that the interest in a 1,2,4-oxadiazoles' biological application has been doubledin the last fifteen years. Herein, after a concise historical introduction, we present a comprehensiveoverview of the recent achievements in the synthesis of 1,2,4-oxadiazole-based compounds and themajor advances in their biological applications in the period of the last five years as well as briefremarks on prospects for further development.
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Affiliation(s)
- Karol Biernacki
- Department of Organic Chemistry, Faculty of Chemistry, Gdansk University of Technology, Narutowicza 11/12, 80-233 Gdansk, Poland; (K.B.); (O.C.); (J.R.)
| | - Mateusz Daśko
- Department of Inorganic Chemistry, Faculty of Chemistry, Gdansk University of Technology, Narutowicza 11/12, 80-233 Gdansk, Poland;
| | - Olga Ciupak
- Department of Organic Chemistry, Faculty of Chemistry, Gdansk University of Technology, Narutowicza 11/12, 80-233 Gdansk, Poland; (K.B.); (O.C.); (J.R.)
| | - Konrad Kubiński
- Department of Molecular Biology, Faculty of Biotechnology and Environment Sciences, The John Paul II Catholic University of Lublin, Konstantynów 1i, 20-708 Lublin, Poland;
| | - Janusz Rachon
- Department of Organic Chemistry, Faculty of Chemistry, Gdansk University of Technology, Narutowicza 11/12, 80-233 Gdansk, Poland; (K.B.); (O.C.); (J.R.)
| | - Sebastian Demkowicz
- Department of Organic Chemistry, Faculty of Chemistry, Gdansk University of Technology, Narutowicza 11/12, 80-233 Gdansk, Poland; (K.B.); (O.C.); (J.R.)
- Correspondence:
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Survival and Cost-Effectiveness of Trabectedin Compared to Ifosfamide Monotherapy in Advanced Soft Tissue Sarcoma Patients. Sarcoma 2019; 2019:3234205. [PMID: 31281207 PMCID: PMC6589299 DOI: 10.1155/2019/3234205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/09/2019] [Indexed: 11/29/2022] Open
Abstract
Trabectedin and ifosfamide are among the few cytostatic agents active in advanced soft tissue sarcomas (STSs). Trabectedin is most potent against so-called L-sarcomas (leiomyosarcoma and liposarcoma). The survival gain and cost-effectiveness of these agents in a second-line setting were analysed in the setting of advanced STS after failure of anthracyclines. A prospective observational trial had previously been performed to assess the use of trabectedin in a Dutch real-world setting. Data on ifosfamide monotherapy were acquired from previous studies, and an indirect comparison of survival was made. A state-transition economic model was constructed, in which patients could be in mutually exclusive states of being preprogression, postprogression, or deceased. The costs and quality-adjusted life years (QALYs) for both treatments were assessed from a Dutch health-care perspective. Separate analyses for the group of L-sarcomas and non-L-sarcomas were performed. Trabectedin treatment resulted in a median progression-free survival of 5.2 months for L-sarcoma patients, 2.0 months for non-L-sarcoma patients, and a median overall survival of 11.8 and 6.0 months, respectively. For L-sarcoma patients, trabectedin offered an increase of 0.368 life years and 0.251 QALYs compared to ifosfamide and €20,082 in additional costs, for an incremental cost-effectiveness ratio (ICER) of €80,000 per QALY gained. In the non-L-sarcoma patients, trabectedin resulted in 0.413 less life years and 0.266 less QALYs, at the increased cost of €4,698. The difference in survival between drugs and the acquisition costs of trabectedin were the main influences in these models. Trabectedin was shown to have antitumour efficacy in advanced L-sarcoma. From a health economics perspective, the costs per QALY gained compared to ifosfamide monotherapy that may be acceptable, considering what is currently regarded as acceptable in the Netherlands.
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Health Care Resource Utilization and Costs among Adult Patients with Advanced Soft Tissue Sarcoma: A Retrospective Medical Record Review in the United Kingdom, Spain, Germany, and France. Sarcoma 2018; 2018:2020591. [PMID: 30297977 PMCID: PMC6157208 DOI: 10.1155/2018/2020591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022] Open
Abstract
Objective To describe health care resource utilization and costs for patients with advanced soft tissue sarcoma (STS) in the United Kingdom (UK), Spain, Germany, and France. Methods Physicians abstracted data for adult patients with a diagnosis of advanced STS (other than Kaposi's sarcoma or gastrointestinal stromal tumor) who received ≥1 lines of systemic therapy. Health care resource utilization related to advanced STS treatment was recorded; associated costs were estimated by applying unit costs. Results A total of 130 physicians provided data for 807 patients (UK: 199; Spain: 203; Germany: 204; and France: 201). The site of care during active treatment varied based on differences in the health care systems of these four countries. Total mean per-patient health care cost in the UK was £19,457; in Spain, €26,814; in Germany, €20,468; and in France, €24,368. Advanced STS-related systemic treatment costs were driven primarily by drug acquisition and administration costs. Treatment-related costs increased during later lines of therapy for all countries except France, where they decreased after first-line therapy. Pain control and antiemetics were the most common supportive care medications. Conclusions This study provides real-world data on resource utilization and estimated costs in advanced STS and could inform policymakers about treatment burden.
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Treatment Patterns and Survival among Adult Patients with Advanced Soft Tissue Sarcoma: A Retrospective Medical Record Review in the United Kingdom, Spain, Germany, and France. Sarcoma 2018; 2018:5467057. [PMID: 29977133 PMCID: PMC5994280 DOI: 10.1155/2018/5467057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/05/2018] [Indexed: 11/18/2022] Open
Abstract
Objective To describe real-world treatment patterns and outcomes for patients with advanced soft tissue sarcoma (STS) not amenable to surgery or radiotherapy in the United Kingdom, Spain, Germany, and France. Methods Physicians completed a web-based medical record abstraction for adult patients with advanced STS (other than Kaposi's sarcoma or gastrointestinal stromal tumor) who received ≥1 line of systemic therapy. Clinical characteristics, treatments, tumor responses, and mortality data were recorded. Results A total of 130 physicians provided data for 807 patients. Patients' mean age at advanced STS diagnosis was 57.1 (±12.3) years; 59% were male. The most commonly identified histologic categories were leiomyosarcoma (28%), liposarcoma (13%), and rhabdomyosarcoma (11%). Overall, 57% of patients received only 1 line of therapy, 32% received 2 lines of therapy, and 11% received ≥3 lines of therapy. The most common first-line regimens were doxorubicin alone (41%), doxorubicin plus ifosfamide (19%), docetaxel plus gemcitabine (9%), paclitaxel alone (4%), and ifosfamide (4%). Median overall survival from start of treatment was estimated to be 17.6 months (95% confidence interval, 15.6–19.0 months). Conclusions In real-world clinical practice, advanced STS is most commonly treated with older therapies in the United Kingdom, Spain, Germany, and France. New therapies that improve overall survival in advanced STS are needed.
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De Sanctis R, Marrari A, Santoro A. Trabectedin for the treatment of soft tissue sarcomas. Expert Opin Pharmacother 2016; 17:1569-77. [PMID: 27328277 DOI: 10.1080/14656566.2016.1204295] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Trabectedin, a marine-derived DNA-binding antineoplastic agent, has been registered by the EMA and recently also by the FDA for the treatment of patients with advanced soft-tissue sarcoma (STS), a rare and heterogeneous disease. AREAS COVERED The antitumor activity of trabectedin is related both to direct effects on cancer cells, such as growth inhibition, cell death and differentiation, and indirect effects related to its anti-inflammatory and anti-angiogenic properties. Furthermore, trabectedin is the first compound that targets an oncogenic transcription factor with high selectivity in mixoid liposarcomas. This peculiar mechanism of action is the basis of its clinical development. The clinical pharmacology of trabectedin, the subsequent phase I, II and III trials are summarized and put into perspectives in this review. EXPERT OPINION Trabectedin is a relevant pleiotropic antitumoral agent within the complex scenario of the management of STS. It can be used in advanced STS, either after failure of anthracyclines and ifosfamide or in patients unfit for these drugs, especially when reaching a high-tumor control and a long-term benefit is a priority. Toxicity profile is acceptable and manageable with no reported cumulative toxicities. Therefore, trabectedin has become one relevant therapeutic option in metastatic STS, especially in selected histologies.
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Affiliation(s)
- Rita De Sanctis
- a Department of Medical Oncology and Hematology , Humanitas Cancer Center IRCCS , Rozzano , Milan , Italy.,b Molecular and Cellular Networks Lab, Department of Anatomy, Histology, Forensic Medicine and Orthopaedics , "Sapienza" University , Rome , Italy
| | - Andrea Marrari
- a Department of Medical Oncology and Hematology , Humanitas Cancer Center IRCCS , Rozzano , Milan , Italy
| | - Armando Santoro
- a Department of Medical Oncology and Hematology , Humanitas Cancer Center IRCCS , Rozzano , Milan , Italy.,c Humanitas University , Rozzano , Milan , Italy
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Jönsson L, Justo N, Musayev A, Krishna A, Burke T, Pellissier J, Judson I, Staddon A, Blay JY. Cost of treatment in patients with metastatic soft tissue sarcoma who respond favourably to chemotherpy. The SArcoma treatment and Burden of Illness in North America and Europe (SABINE) study. Eur J Cancer Care (Engl) 2015; 25:466-77. [PMID: 25923192 DOI: 10.1111/ecc.12322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2015] [Indexed: 12/01/2022]
Abstract
Treatment of metastatic soft tissue sarcoma (mSTS) commonly includes multiple lines of chemotherapy, until a decline in performance status precludes further treatment. The primary objective of this study was to describe the lifetime healthcare resource utilisation and cost among mSTS patients with favourable response to chemotherapy. SABINE was a multi-centre (n = 25), multi-country (n = 9) retrospective chart review study of mSTS patients with favourable response to chemotherapy following 4 cycles. Healthcare resource utilisation was collected from first line until death or end of follow-up. Costs were analysed by health states (defined by treatment line, chemotherapy use and disease progression) and estimated by multiplying the mean weekly cost per health state by the expected number of weeks spent in each health state. Expected per-patient lifetime medical cost was €65 616 (95% CI: €51 454-€85 003); comprised of IV chemotherapy (31.7%), inpatient care (24.8%), concomitant medication (11.0%), oral chemotherapy (8.9%), outpatient visits (8.8%), radiotherapy (6.3%), hospice (4.0%), imaging (3.7%) and laboratory (0.7%). Weekly costs were 280-330% higher during chemotherapy treatment periods than off-chemotherapy, especially after disease progression. Per-patient costs were highest in the USA and lowest in the Netherlands and UK. The economic burden of mSTS is considerable and the amount of resources devoted to its treatment varies across countries.
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Affiliation(s)
- L Jönsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institut, Stockholm
| | - N Justo
- Mapi Group, Stockholm, Sweden
| | | | - A Krishna
- Novartis Pharmaceuticals Corporation, Florham Park, NJ, USA
| | - T Burke
- Global Health Outcomes, Oncology, Global Health Outcomes, Merck, Whitehouse Station, NJ, USA
| | - J Pellissier
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - I Judson
- Royal Marsden Hospital, London, UK
| | - A Staddon
- Abramson Cancer Center, Pennsylvania Hospital, Philadelphia, PA, 19106, USA
| | - J Y Blay
- Centre Léon Bérard, University Claude Bernard Lyon I, Lyon Cedex, France
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