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Kasper B, Pink D, Rothermundt C, Richter S, Augustin M, Kollar A, Kunitz A, Eisterer W, Gaidzik V, Brodowicz T, Egerer G, Reichardt P, Hohenberger P, Schuler MK. Geriatric Assessment of Older Patients Receiving Trabectedin in First-Line Treatment for Advanced Soft Tissue Sarcomas: The E-TRAB Study from The German Interdisciplinary Sarcoma Group (GISG-13). Cancers (Basel) 2024; 16:558. [PMID: 38339308 PMCID: PMC10854510 DOI: 10.3390/cancers16030558] [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: 12/29/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
E-TRAB was a non-interventional, prospective trial investigating the feasibility and predictive value of geriatric assessments (GA) in older STS patients treated with trabectedin as first-line therapy. Primary endpoints were overall survival (OS), quality of life and individual clinical benefit assessed by the patient-reported outcome measures QLQ-C30 and PRO-CTCAE. Further, several GA tools were applied and correlated with clinical outcomes and treatment-related toxicities. The final analyses included 69 patients from 12 German-speaking sites. The median age of patients was 78 years (range: 55 to 88). Baseline data on PROs and GA identified a diverse population of older patients with respect to their global health status, although a large proportion of them suffered from limitations, required geriatric help and had a high risk of morbidity. The Cancer and Age Research Group (CARG) score classified 38%, 29% and 23% of the patients with low, intermediate and high risks for therapy-related side effects, respectively. Median OS was 11.2 months [95%CI: 5.6; 19.4]. The study confirmed that trabectedin as first-line treatment in older patients with STS has an acceptable and manageable safety profile. Potential prognostic factors for clinical outcome and therapy-related toxicity were identified among the GA tools. Long Timed Up and Go (TUG) showed a significant correlation to OS and early death, whereas a high CARG score (>9) was associated with an increase in unplanned hospitalizations and the incidence of toxicities grade ≥ 3.
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Affiliation(s)
- Bernd Kasper
- Sarcoma Unit, Mannheim Cancer Center (MCC), Mannheim University Medical Center, University of Heidelberg, 68167 Mannheim, Germany
| | - Daniel Pink
- Department of Oncology and Palliative Care, HELIOS Klinikum Bad Saarow, 15526 Bad Saarow, Germany;
- Department of Internal Medicine C, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Christian Rothermundt
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland;
| | - Stephan Richter
- Medical Department I, University Hospital Carl Gustav Carus, Dresden University of Technology, 01307 Dresden, Germany
| | - Marinela Augustin
- Department of Hematology and Oncology, Paracelsus Medical University, 90419 Nuremberg, Germany;
| | - Attila Kollar
- Department of Medical Oncology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Annegret Kunitz
- Department of Hematology, Oncology and Palliative Medicine, Vivantes Klinikum Spandau, 13585 Berlin, Germany;
| | - Wolfgang Eisterer
- Clinical Division of Oncology, Department of Internal Medicine, Medical University Graz, 8036 Graz, Austria;
| | - Verena Gaidzik
- Clinic for Internal Medicine III, University Hospital Ulm, 89081 Ulm, Germany;
| | - Thomas Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, 1090 Vienna, Austria;
| | - Gerlinde Egerer
- Department of Internal Medicine V, Heidelberg University Hospital, 69120 Heidelberg, Germany;
| | - Peter Reichardt
- Department of Oncology, Helios Klinikum Berlin-Buch, 13125 Berlin, Germany;
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, University Medical Center Mannheim, Mannheim Medical Faculty, University of Heidelberg, 68167 Mannheim, Germany
| | - Markus K. Schuler
- Medical Department I, University Hospital Carl Gustav Carus, Dresden University of Technology, 01307 Dresden, Germany
- Onkologischer Schwerpunkt am Oskar-Helene Heim, 14195 Berlin, Germany
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Kruiswijk AA, van de Sande MAJ, Verhoef C, Schrage YM, Haas RL, Bemelmans MHA, van Ginkel RJ, Bonenkamp JJ, Witkamp AJ, van den Akker-van Marle ME, Marang-van de Mheen PJ, van Bodegom-Vos L. Changes in Health-Related Quality of Life following Surgery in Patients with High-Grade Extremity Soft-Tissue Sarcoma: A Prospective Longitudinal Study. Cancers (Basel) 2024; 16:547. [PMID: 38339298 PMCID: PMC10854952 DOI: 10.3390/cancers16030547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Changes in health-related quality of life (HRQoL) during the diagnostic and treatment trajectory of high-grade extremity soft-tissue sarcoma (eSTS) has rarely been investigated for adults (18-65 y) and the elderly (aged ≥65 y), despite a potential variation in challenges from diverse levels of physical, social, or work-related activities. This study assesses HRQoL from time of diagnosis to one year thereafter among adults and the elderly with eSTS. METHODS HRQoL of participants from the VALUE-PERSARC trial (n = 97) was assessed at diagnosis and 3, 6 and 12 months thereafter, utilizing the PROMIS Global Health (GH), PROMIS Physical Function (PF) and EQ-5D-5L. RESULTS Over time, similar patterns were observed in all HRQoL measures, i.e., lower HRQoL scores than the Dutch population at baseline (PROMIS-PF:46.8, PROMIS GH-Mental:47.3, GH-Physical:46.2, EQ-5D-5L:0.76, EQ-VAS:72.6), a decrease at 3 months, followed by an upward trend to reach similar scores as the general population at 12 months (PROMIS-PF:49.9, PROMIS GH-Physical:50.1, EQ-5D-5L:0.84, EQ-VAS:81.5), except for the PROMIS GH-Mental (47.5), where scores remained lower than the general population mean (T = 50). Except for the PROMIS-PF, no age-related differences were observed. CONCLUSIONS On average, eSTS patients recover well physically from surgery, yet the mental component demonstrates no progression, irrespective of age. These results underscore the importance of comprehensive care addressing both physical and mental health.
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Affiliation(s)
- Anouk A. Kruiswijk
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands (L.v.B.-V.)
- Orthopedic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | | | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands;
| | - Yvonne M. Schrage
- Department of Surgical Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
| | - Rick L. Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
- Department of Radiotherapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Marc H. A. Bemelmans
- Department of Surgical Oncology, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Robert J. van Ginkel
- Department of Surgical Oncology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Johannes J. Bonenkamp
- Department of Surgery, Radboud University Medical Center, 6525 EP Nijmegen, The Netherlands;
| | - Arjen J. Witkamp
- Department of Surgical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - M. Elske van den Akker-van Marle
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands (L.v.B.-V.)
| | - Perla J. Marang-van de Mheen
- Safety & Security Science and Centre for Safety in Healthcare, Delft University of Technology, 2826 CN Delft, The Netherlands;
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands (L.v.B.-V.)
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Singh A, Thorpe S, Keegan T, Maguire F, Malogolowkin M, Abrahão R, Spunt S, Carr-Asher J, Alvarez E. Localized Synovial Sarcoma: A Population-Based Analysis of Treatment Patterns and Survival. J Adolesc Young Adult Oncol 2023; 12:634-643. [PMID: 37104039 PMCID: PMC10611969 DOI: 10.1089/jayao.2022.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Purpose: Synovial sarcoma (SS) is a rare, high-grade soft tissue tumor that requires multidisciplinary and multimodal care with surgery, radiotherapy, and chemotherapy. We examined the impact of sociodemographic and clinical factors on treatment patterns and survival in localized SS patients. Methods: Adolescents and young adults (AYAs, 15-39 years) and older adults ("adults," ≥40 years) diagnosed with localized SS from 2000 to 2018 were identified in the California Cancer Registry. Multivariable logistic regression identified clinical and sociodemographic factors associated with receipt of chemotherapy and/or radiotherapy. Cox proportional hazards regression identified factors associated with overall survival (OS). Results are reported as odds ratios (ORs) and hazard ratios (HRs), respectively, with 95% confidence intervals (CIs). Results: More AYAs (n = 346) than adults (n = 272) received chemotherapy (47.7% vs. 36.4%) and radiotherapy (62.1% vs. 58.1%). Age at diagnosis, tumor size, treatment at National Cancer Institute-Children's Oncology Group (NCI-COG)-designated facilities, insurance status, and neighborhood socioeconomic status (SES) influenced treatment patterns. Among AYAs, treatment at NCI-COG-designated facilities was associated with receiving chemotherapy (OR 2.74, CI 1.48-5.07) and low SES was associated with worse OS (HR 2.28, 1.09-4.77). In adults, high SES was associated with receiving chemoradiotherapy (OR 3.20, CI 1.40-7.31), whereas public insurance was associated with decreased odds of chemoradiotherapy (OR 0.44, CI 0.20-0.95). With regard to treatment, absence of radiotherapy (HR 1.94, CI 1.18-3.20) was associated with worse OS in adults. Conclusion: In localized SS, both clinical and sociodemographic factors influenced treatment patterns. Further research should investigate how SES-related factors produce treatment disparities and identify interventions to improve treatment equity and outcomes.
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Affiliation(s)
- Amisha Singh
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Steven Thorpe
- Department of Orthopedic Surgery, University of California, Davis Comprehensive Cancer Center, Orange, California, USA
| | - Theresa Keegan
- Division of Hematology and Oncology, University of California, Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Frances Maguire
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Marcio Malogolowkin
- Division of Pediatric Hematology/Oncology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Renata Abrahão
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis, Sacramento, California, USA
- Center for Healthcare Policy & Research, University of California Davis, Sacramento, California, USA
| | - Sheri Spunt
- Pediatric Hematology/Oncology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Janai Carr-Asher
- Division of Hematology and Oncology, University of California, Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Elysia Alvarez
- Division of Pediatric Hematology/Oncology, University of California Davis School of Medicine, Sacramento, California, USA
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Hamacher R, Liu X, Schuler MK, Hentschel L, Schöffski P, Kopp HG, Bauer S, Kasper B, Lindner L, Chemnitz JM, Crysandt M, Stein A, Steffen B, Richter S, Egerer G, Ivanyi P, Kunitz A, Grünwald V. A post hoc analysis of the EPAZ trial: The role of geriatric variables in elderly soft tissue sarcoma patients on toxicity and outcome. Eur J Cancer 2023; 181:145-154. [PMID: 36657323 DOI: 10.1016/j.ejca.2022.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The EPAZ study (NCT01861951) showed recently that pazopanib was non-inferior to doxorubicin in patients ≥60 years treated in first line for advanced soft tissue sarcoma . The current post-hoc analysis aimed to assess the prognostic impact of frailty. METHODS Geriatric assessments were evaluated at baseline. Age >75 years, liposarcoma, ECOG = 2, G8 ≤14, instrumental activities of daily living (IADL) ≥1 and Charlson Comorbidity Index ≥2 were tested for their impact on progression-free survival (PFS), overall survival (OS), CTCAE grade 3/4 adverse events (AEs) or serious AEs (SAEs), using univariate and multivariate analysis models. RESULTS univariate analysis showed an increased risk of grade 3/4 AEs and SAEs for ECOG = 2, G8 score ≤14 or IADL ≥1, independent of treatment. The multivariate analysis exhibited for pazopanib a significantly reduced risk for grade 3/4 AEs (HR 0.53; p = 0.033), and in patients with G8 ≤14 an increased risk for SAEs (HR 2.67; p = 0.011). In the multivariate analysis, G8 ≤14 was a negative prognostic factor for PFS (HR 1.82; p = 0.009) and IADL ≥1 for OS (HR 2.02; p = 0.007). ECOG = 2 was the strongest negative predictor for PFS (HR 4.39; p = 0.001) and OS (HR 3.74; p = 0.004). Neither age nor Charlson Comorbidity Index showed any impact on PFS, OS, incidence of grade 3/4 AEs or SAEs. CONCLUSIONS This post hoc analysis demonstrated that age is not a denominator for outcome or toxicity in elderly patients with soft tissue sarcoma . Instead, geriatric and functional assessments should be used to counsel patients and tailor therapy to individual needs. Moreover, pazopanib has a reduced risk for grade 3/4 AEs compared to doxorubicin.
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Affiliation(s)
- Rainer Hamacher
- Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Xiaofei Liu
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Markus K Schuler
- Division of Hematology, Oncology and Stem Cell Transplantation, Medical Clinic I, Department of Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Leopold Hentschel
- National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus, Dresden, Germany
| | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Hans-Georg Kopp
- Robert Bosch Centrum für Tumorerkrankungen Stuttgart, Stuttgart, Germany
| | - Sebastian Bauer
- Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Bernd Kasper
- Sarcoma Unit, Mannheim University Medical Center, Mannheim, Germany
| | - Lars Lindner
- Department of Medicine III, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Jens-Markus Chemnitz
- Community Hospital Middle Rine, Middle Rine, Germany; Department of Hematology, Oncology, Clinical Infectious Diseases, Clinical Immunology, Hemostaseology and Medical Intensive Care, University Hospital Cologne, Cologne, Germany
| | - Martina Crysandt
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Alexander Stein
- University Hospital Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | | | - Stephan Richter
- National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Philipp Ivanyi
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Medical School Hannover, Hannover, Germany
| | - Annegret Kunitz
- Vivantes Clinic Berlin-Spandau, Berlin-Spandau, Germany; Department of Hematology, Oncology and Tumor Immunology, University Hospital Charite, Berlin, Germany
| | - Viktor Grünwald
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany; Interdisciplinary Genitourinary Oncology at the West-German Cancer Center, Clinic for Internal Medicine (Tumor Research) and Clinic for Urology, University Hospital Essen, Essen, Germany.
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Management and Outcomes of Older Patients (Age ≥ 70 Years) with Advanced Soft Tissue Sarcoma and Role of Geriatric Assessment and Oncological Multidimensional Prognostic Index (Onco-MPI) in a Real-World Setting. Cancers (Basel) 2023; 15:cancers15041043. [PMID: 36831386 PMCID: PMC9953908 DOI: 10.3390/cancers15041043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
Background: Incidences of soft tissue sarcomas (STS) steadily increase with age. Yet, despite the high prevalence in advanced age, older patients (pts) are underrepresented in sarcoma clinical trials and evidence-based guidelines for chemotherapy are lacking. International oncological societies suggest using geriatric tools to evaluate older patients with cancer to optimise treatment indication. Comprehensive geriatric assessment (CGA) is a multidimensional assessment of older subjects, based on which pts can be classified as fit, vulnerable or frail. Onco-MPI (multidimensional prognostic index) is a CGA-based score which also considers tumour characteristics, classifying pts into three risk groups of death at one year: high-risk, intermediate-risk and low-risk. Methods: This is a single-centre retrospective study which aims at describing real-word management and outcomes of older pts with advanced stage STS and at assessing the ability of CGA and onco-MPI to predict survival in these pts. Consecutive pts with advanced stage STS aged 70 years or older and treated at the Istituto Oncologico Veneto from January 2009 to June 2020 were retrieved from a prospectively maintained database. Pts' demographics, CGA assessments and tumour characteristics were analysed. Statistical analysis was performed with R version 3.4.3 Results: Out of 101 pts, with a median age of 77 years, 76 received chemotherapy (75.3%), which was anthracycline-based for 46 pts (60.5%). Anthracyclines were used in a higher proportion in fit pts (58.9% fit vs. 45.1% vulnerable vs. 12.5% frail pts). Frail pts and pts in the onco-MPI high-risk group experienced a higher rate of chemotherapy-related toxicities. Median OS was 13.8 months (95% CI 11.3-17.7 months). According to CGA, the median OS was 19.53 months (95% CI 15.23-36.8) for fit pts, 12.83 months (95% CI 9.7-17.5) for vulnerable and 7.75 months (95% CI 2.73-30) for frail pts (p = 0.005). Onco-MPI confirmed a predictive value for 1-year survival with intermediate risk pts not reaching a median OS at 1 year, and high-risk pts having a median one-year OS of 11.5 months (95%CI 9.7-NA), p = 0.02. In multivariate analysis, onco-MPI and CGA were associated with survival (high risk onco-MPI: HR 5.5, 95%CI 1.25-24.7 p = 0.02; fitness at CGA HR 0.552 95% 0.314-0.973; p = 0.040) as well as chemotherapy use (HR 0.24, 95% CI 0.11-0.51, p < 0.005). Conclusions: Both CGA and onco-MPI retain prognostic value for survival in pts with metastatic STS. Pts frail/vulnerable at CGA and pts within the onco-MPI high risk category should be offered an oncogeriatric management approach in order to optimise treatment-related survival and reduce toxicity.
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Weiss MC. Systemic Treatment of Soft Tissue Sarcomas in the Geriatric Population. Curr Treat Options Oncol 2022; 23:855-863. [PMID: 35389146 DOI: 10.1007/s11864-022-00972-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/24/2022]
Abstract
OPINION STATEMENT As the population ages, there will be an increase in the incidence and prevalence of soft tissue sarcoma (STS) within the geriatric population. As this disease disproportionately affects older adults, the percentage of adults >65 years old is expected to increase in the coming years. Geriatric patients are often more vulnerable to disease-related symptoms and have more difficulty tolerating treatment-related side effects. While there are no formal existing guidelines to direct the care of this geriatric patient population, it is of utmost importance to consider each patients' fitness and co-morbidities when selecting treatment plans. This review focuses on the current state of research of older adults with advanced or metastatic soft tissue sarcoma, highlighting the lack of representation of this patient population in clinical trials. Given that chronological age does not necessarily equate to physiologic age, integration of comprehensive geriatric and quality of life assessments is needed in the care of geriatric patients to help guide therapeutic decisions.
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Affiliation(s)
- Mia C Weiss
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, MO, 63110, USA. .,Siteman Cancer Center, St. Louis, MO, 63110, USA.
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Evaluation of the efficacy of CT-guided 3D template-assisted 125I seed implantation in the treatment of unresectable STS: a multicenter retrospective study. Sci Rep 2022; 12:3731. [PMID: 35260674 PMCID: PMC8904573 DOI: 10.1038/s41598-022-07729-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/22/2022] [Indexed: 11/09/2022] Open
Abstract
To observe the safety and efficacy of CT-guided 3D template-assisted radioactive 125I seed implantation in the treatment of unresectable advanced soft tissue sarcoma (STS). Sixty-two patients who underwent continuous 3D template-assisted radioactive 125I seed implantation for the treatment of unresectable advanced STS from August 2017 to August 2018 were selected from four tumor treatment centers for retrospective analysis. The postoperative adverse reactions and tumor response were recorded, and the postoperative complications were observed and treated at the same time. The overall survival (OS) rate was determined. All patients successfully completed 125I seed implantation. In practice, the median number of puncture needles used during the operation was 20, and the median number of 125I particles was 88. There were no statistical differences in the relative dosimetry parameters before and after the operation (P > 0.05). Tumor evaluation was performed 6 months after the operation. The effective rate was 61.3%, and the local control rate was 93.5%. As of March 2020, the 1-year survival rate was 85.2%, and the 2-year survival rate was 49.0%. The OS was 23 months. CT-guided 3D template-assisted 125I seed implantation for the treatment of unresectable STS has a high local control rate, thereby further prolonging the OS of patients with unresectable STS.
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Nakamura T, Sudo A. Treatment Strategy for Elderly Patients with Soft Tissue Sarcoma. Curr Oncol Rep 2022; 24:563-571. [PMID: 35192116 DOI: 10.1007/s11912-022-01244-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Surgical resection is the standard treatment for localized soft tissue sarcoma (STS), while systemic chemotherapy for advanced STS may be considered. However, less aggressive treatment is often administered to elderly patients with STS. Undertreatment may compromise the cure rate and survival of these individuals. We review the literatures and emphasize the importance of standard treatment for STS in elderly patients. RECENT FINDINGS The outcome of surgical resection of STS in older individuals is comparable to that of younger ones, as long as patients are selected based on American Society of Anesthesiologists Physical Status (ASA-PS). Likewise, systemic treatment may prove beneficial as long as the risk of complications is estimated with a geriatric assessment. Elderly patients with STS benefit from standard treatment as long as the risks of surgical and systemic complications are assessed respectively with the ASA-PS and GA. Novel clinical trials with broader eligibility criteria are also necessary for elderly patients because of the increasing population of the elderly patients in the future.
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Affiliation(s)
- Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan.
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan
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Hartley LJ, AlAqeel M, Kurisunkal VJ, Evans S. Outcomes of soft-tissue sarcoma in nonagenarians. Bone Joint J 2022; 104-B:177-182. [PMID: 34969278 DOI: 10.1302/0301-620x.104b1.bjj-2021-0761.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Current literature suggests that survival outcomes and local recurrence rates of primary soft-tissue sarcoma diagnosed in the very elderly age range, (over 90 years), are comparable with those in patients diagnosed under the age of 75 years. Our aim is to quantify these outcomes with a view to rationalizing management and follow-up for very elderly patients. METHODS Retrospective access to our prospectively maintained oncology database yielded a cohort of 48 patients across 23 years with a median follow-up of 12 months (0 to 78) and mean age at diagnosis of 92 years (90 to 99). Overall, 42 of 48 of 48 patients (87.5%) were managed surgically with either limb salvage or amputation. RESULTS A lower overall local recurrence rate (LRR) was seen with primary amputations compared with limb salvage (p > 0.050). The LRR was comparable between free (R0), microscopically (R1), and macroscopically positive (R2) resection margins in the limb salvage group. Amputation was also associated with longer survival times (p < 0.050). Overall median survival time was limited to 20 months (0 to 80). CONCLUSION Early and aggressive treatment with appropriate oncological surgery confers the lowest LRR and a survival advantage versus conservative treatment in this cohort of patients. With limited survival, follow-up can be rationalized on a patient-by-patient basis using alternative means, such as GP, local oncology, and/or patient-led follow-up. Cite this article: Bone Joint J 2022;104-B(1):177-182.
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Affiliation(s)
- Laura J Hartley
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Motaz AlAqeel
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Scott Evans
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Zhang XY, Liu J, Deng YT, Jiang Y. Anlotinib treatment in elderly patients with unresectable or metastatic soft tissue sarcoma: a retrospective study. Anticancer Drugs 2022; 33:e519-e524. [PMID: 34282747 DOI: 10.1097/cad.0000000000001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Palliative chemotherapy can improve outcomes in most patients with advanced soft tissue sarcoma (STS), but the treatment of elderly patients remains a challenge because of older age, comorbidities and poor performance status. This study retrospectively analyzed the efficacy and safety of the multi-targeted tyrosine kinase inhibitor anlotinib in elderly patients with advanced STS. Eligible patients included those of age at least 60 years, diagnosed with unresectable or metastatic STS, and treated with at least one cycle of anlotinib between June 2018 and September 2020 in our center. Clinical characteristics, treatment response, survival status and adverse events were analyzed by reviewing medical records. The median age of 35 eligible patients was 65 (range, 61-85) years, and the median Charlson Comorbidity Index score was 8 (range, 4-11). Anlotinib as first-line systemic treatment was in 24 (68.6%) patients, and as second-line or third-line treatment in the remaining 11 (31.4%) patients. The objective response rate was 8.6%. The median progression-free survival was 5.5 [95% confidence interval (CI), 1.4-9.6] months and the median overall survival was 14.3 (95% CI, 9.6-19.0) months. Thirteen (37.1%) patients developed at least one grade 3/4 adverse event during anlotinib treatment. Our findings suggest that anlotinib treatment has promising efficacy and an acceptable toxicity profile in elderly patients with unresectable or metastatic STS. Prospective controlled trials are needed to compare the safety and efficacy of anlotinib and chemotherapy as first-line treatment in elderly patients with advanced STS.
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Affiliation(s)
- Xin-Yao Zhang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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11
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Wang BC, Kuang BH, Xiao BY, Lin GH. Doxorubicin/Adriamycin Monotherapy or Plus Ifosfamide in First-Line Treatment for Advanced Soft Tissue Sarcoma: A Pooled Analysis of Randomized Trials. Front Oncol 2021; 11:762288. [PMID: 34881180 PMCID: PMC8648074 DOI: 10.3389/fonc.2021.762288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/28/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Doxorubicin/Adriamycin (ADM) alone or combined with ifosfamide (IFO) (AI) is available for previously untreated advanced soft tissue sarcoma (ASTS). However, the clinical choice between them remains controversial. In this pooled analysis, we comprehensively compared the efficacy and tolerability of AI versus ADM in patients with ASTS. METHODS PubMed, Web of Science, EMBASE, and Cochrane Library were systematically searched from inception to April 14, 2021. Eligible studies were randomized clinical trials comparing AI to ADM. The primary outcomes were overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). Discontinuation rate (DR) and toxic death (TD) were explored as secondary outcomes. RESULTS Overall, three open-label randomized phase 2/3 clinical trials with a total of 1108 newly diagnosed ASTS patients were enrolled. Between AI and ADM, pooled hazard ratios were 0.93 (95% confidence interval 0.58-1.50, p = 0.78) for OS and 0.85 (0.57-1.25, p = 0.41) for PFS. While pooled risk ratios for ORR, DR, and TD were 1.37 (0.94-1.99, p = 0.10), 1.04 (0.74-1.46, p = 0.82), and 0.68 (0.19-2.36, p = 0.54) respectively. No publication bias was observed across the studies. CONCLUSION In the first-line setting, adding IFO to ADM failed to benefit ASTS patients against ADM alone, even with comparable tolerability.
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Affiliation(s)
- Bi-Cheng Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo-Hua Kuang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo-Ya Xiao
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Guo-He Lin
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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12
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Strassmann D, Hensen B, Grünwald V, Stange K, Eggers H, Länger F, Omar M, Zardo P, Christiansen H, Reuter CW, Wacker FK, Ganser A, Ivanyi P. Impact of sarcopenia in advanced and metastatic soft tissue sarcoma. Int J Clin Oncol 2021; 26:2151-2160. [PMID: 34318390 PMCID: PMC8520878 DOI: 10.1007/s10147-021-01997-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/18/2021] [Indexed: 12/27/2022]
Abstract
Introduction Advanced or metastatic soft tissue sarcoma (a/mSTS) is associated with a dismal prognosis. Patient counseling on treatment aggressiveness is pivotal to avoid over- or undertreatment. Recently, evaluation of body composition markers like the skeletal muscle index (SMI) became focus of interest in a variety of cancers. This study focuses on the prognostic impact of SMI in a/mSTS, retrospectively. Methods 181 a/mSTS patients were identified, 89 were eligible due to prespecified criteria for SMI assessment. Baseline CT-Scans were analyzed using an institutional software solution. Sarcopenia defining cut-off values for the SMI were established by optimal fitting method. Primary end point was overall survival (OS) and secondary endpoints were progression free survival (PFS), disease control rate (DCR), overall response rate (ORR). Descriptive statistics as well as Kaplan Meier- and Cox regression analyses were administered. Results 28/89 a/mSTS patients showed sarcopenia. Sarcopenic patients were significantly older, generally tended to receive less multimodal therapies (62 vs. 57 years, P = 0.025; respectively median 2.5 vs. 4, P = 0.132) and showed a significantly lower median OS (4 months [95%CI 1.9–6.0] vs. 16 months [95%CI 8.8–23.2], Log-rank P = 0.002). Sarcopenia was identified as independent prognostic parameter of impaired OS (HR 2.40 [95%-CI 1.4–4.0], P < 0.001). Moreover, DCR of first palliative medical treatment was superior in non-sarcopenic patients (49.2% vs. 25%, P = 0.032). Conclusion This study identifies sarcopenia as a prognostic parameter in a/mSTS. Further on, the data suggest that sarcopenia shows a trend of being associated with first line therapy response. SMI is a promising prognostic parameter, which needs further validation.
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Affiliation(s)
- Dennis Strassmann
- Klinik Für Hämatologie, Hämostaseologie, Onkologie Und Stammzelltransplantation, Medizinische Hochschule Hannover, OE 6860, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Bennet Hensen
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Viktor Grünwald
- Clinic for Urology and Clinic for Medical Oncology, Interdisciplinary GU Oncology, University Hospital Essen, Essen, Germany
| | - Katharina Stange
- Klinik Für Hämatologie, Hämostaseologie, Onkologie Und Stammzelltransplantation, Medizinische Hochschule Hannover, OE 6860, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Hendrik Eggers
- Klinik Für Hämatologie, Hämostaseologie, Onkologie Und Stammzelltransplantation, Medizinische Hochschule Hannover, OE 6860, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Florian Länger
- Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
| | - Mohamed Omar
- Department of Orthopedics and Trauma, Hannover Medical School, Hannover, Germany
| | - Patrick Zardo
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Hans Christiansen
- Department of Radiotherapy, Hannover Medical School, Hannover, Germany
| | - Christoph W. Reuter
- Klinik Für Hämatologie, Hämostaseologie, Onkologie Und Stammzelltransplantation, Medizinische Hochschule Hannover, OE 6860, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Frank K. Wacker
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Arnold Ganser
- Klinik Für Hämatologie, Hämostaseologie, Onkologie Und Stammzelltransplantation, Medizinische Hochschule Hannover, OE 6860, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Philipp Ivanyi
- Klinik Für Hämatologie, Hämostaseologie, Onkologie Und Stammzelltransplantation, Medizinische Hochschule Hannover, OE 6860, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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13
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Arifi S, Constantinidou A, Jones R. Managing the risk of toxicity in the treatment of elderly patients with soft tissue sarcomas. Expert Opin Drug Saf 2021; 20:903-913. [PMID: 33956569 DOI: 10.1080/14740338.2021.1915985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Nearly half of soft tissue sarcomas (STS) occur after the age of 65 years. Treating these patients is a complex issue in the absence of specific guidelines. AREAS COVERED This is a narrative review that summarizes current data on the efficacy and the safety of different treatment strategies in this subpopulation. EXPERT OPINION Age per se should not be a limiting factor to treatment. Surgery remains the treatment of choice offering the only chance of cure. The potential for benefit from adjuvant therapies must be discussed in the context of expected treatment-related toxicities and impairment of quality of life. Efficacy of systemic treatment in advanced disease did not differ from that in younger patients. However, safety must be considered when selecting treatments. Managing the risk of toxicity requires an assessment of vulnerabilities with validated tools. The Comprehensive geriatric assessment has become increasingly accepted but need to be validated in STS patients. Frailty should not exclude patients from potentially life-saving therapy. The correction of reversible conditions and active supportive care may make the treatment safer. Future studies are warranted to define better the patterns, benefits, risks of existing treatments. New options remain to be identified to reduce toxicity.
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Affiliation(s)
- Samia Arifi
- Medical Oncology Department, Hassan II University hospital/Faculty of Medicine and Pharmacy. University of Sidi Mohamed Ben Abdellah. Fez, Morocco
| | - Anastasia Constantinidou
- Medical School, University of Cyprus, Nicosia, Cyprus.,Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Robin Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
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14
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Drabbe C, Van der Graaf WTA, De Rooij BH, Grünhagen DJ, Soomers VLMN, Van de Sande MAJ, Been LB, Keymeulen KBMI, van der Geest ICM, Van Houdt WJ, Husson O. The age-related impact of surviving sarcoma on health-related quality of life: data from the SURVSARC study. ESMO Open 2021; 6:100047. [PMID: 33516150 PMCID: PMC7844567 DOI: 10.1016/j.esmoop.2021.100047] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) data of sarcoma survivors are scarce and the impact of age remains unclear. The aims of this population-based study were to (i) compare HRQoL scores amongst three age-groups [adolescents and young adults (AYA, aged 18-39 years), older adults (OA, aged 40-69 years) and elderly (aged ≥70 years)]; (ii) compare HRQoL of each sarcoma survivor age group with an age- and sex-matched normative population sample; (iii) determine factors associated with low HRQoL per age group. METHODS Dutch sarcoma survivors, who were 2-10 years after diagnosis, were invited to complete the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions questionnaire on HRQoL. RESULTS In total, 1099 survivors (58% response rate) completed the questionnaire: 186 AYAs, 748 OAs and 165 elderly. The median time since diagnosis for all patients was 5.2 years. Bone sarcomas were seen in 41% of AYAs, 22% of OAs and in 16% of elderly survivors (P < 0.01). AYA and OA survivors reported statistically significant and clinically meaningful worse physical, role, cognitive, emotional and social functioning compared with a matched norm population, which was not the case for elderly survivors. AYAs reported significantly worse scores on emotional and cognitive functioning compared with OA and elderly survivors. Malignant peripheral nerve sheath tumour, osteosarcoma and chordoma were the subtypes of which survivors reported the lowest HRQoL scores in comparison with the norm. For all age groups, chemotherapy, having a bone sarcoma and having comorbidities were most frequently associated with low scores on HRQoL subscales, whereas a shorter time since diagnosis was not. CONCLUSION In this nationwide sarcoma survivorship study, the disease and its treatment had relatively more impact on the HRQoL of AYA and OA survivors than on elderly survivors. These results emphasise the need for personalised follow-up care that not only includes risk-adjusted care related to disease relapse, but also age-adjusted care.
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Affiliation(s)
- C Drabbe
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W T A Van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - B H De Rooij
- Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - D J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - V L M N Soomers
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M A J Van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - L B Been
- Department of Surgical Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | - K B M I Keymeulen
- Department of Surgical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - I C M van der Geest
- Department of Orthopaedics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - W J Van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - O Husson
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Institute of Cancer Research, Sutton, London, UK.
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15
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Tsuchihashi K, Kusaba H, Yoshihiro T, Fujiwara T, Setsu N, Endo M, Matsumoto Y, Imajima T, Shinohara Y, Ito M, Yamaga S, Tanoue K, Arimizu K, Ohmura H, Hanamura F, Yamaguchi K, Isobe T, Ariyama H, Nakashima Y, Akashi K, Baba E. Eribulin as a first-line treatment for soft tissue sarcoma patients with contraindications for doxorubicin. Sci Rep 2020; 10:20896. [PMID: 33262403 PMCID: PMC7708971 DOI: 10.1038/s41598-020-77898-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/17/2020] [Indexed: 11/18/2022] Open
Abstract
Doxorubicin is a first-line therapy for patients with unresectable advanced soft tissue sarcoma (STS). However, because of cardiotoxicities, it is not used for patients with cardiac problems. Eribulin has exhibited efficacy for advanced STS in second- or later-line treatments. In the present study, we retrospectively analyzed the efficacy and safety of first-line eribulin therapy for patients with advanced STS unable to receive doxorubicin. Six of 28 patients who received eribulin as any line treatment received eribulin as a first-line treatment. The reasons for avoiding doxorubicin were as follows: cardiac problems for four patients and advanced age for two. Median progression-free survival (PFS) of the patients who received eribulin as first-line and, second or later-line therapy were 9.7 months (95% CI: 1.0-not reached) and 3.9 months (95% CI: 2.7–5.9), which were not significantly different. The reasons for discontinuation of eribulin were disease progression and adverse events (2 fatigue and 1 neuropathy) for three patients each. No treatment-related cardiotoxicity was observed. The findings of this study indicated that eribulin exhibits meaningful efficacy for the patients with contraindications for doxorubicin as a first-line treatment without cardiac adverse events. However, appropriate safety management is necessary because older patients are typically among those intolerable of doxorubicin.
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Affiliation(s)
- Kenji Tsuchihashi
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, 812-8582, Japan
| | - Hitoshi Kusaba
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, 812-8582, Japan
| | - Tomoyasu Yoshihiro
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Toshifumi Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Nokitaka Setsu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Makoto Endo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Takashi Imajima
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, 812-8582, Japan
| | - Yudai Shinohara
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, 812-8582, Japan
| | - Mamoru Ito
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, 812-8582, Japan
| | - Satoru Yamaga
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Kenro Tanoue
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Kohei Arimizu
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Hirofumi Ohmura
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Fumiyasu Hanamura
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Kyoko Yamaguchi
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Taichi Isobe
- Department of Oncology and Social Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Hiroshi Ariyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Eishi Baba
- Department of Oncology and Social Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
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16
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The challenge of treating elderly patients with advanced bone and soft tissue sarcomas. Crit Rev Oncol Hematol 2020; 155:103108. [DOI: 10.1016/j.critrevonc.2020.103108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/24/2020] [Accepted: 09/07/2020] [Indexed: 01/13/2023] Open
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17
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Grünwald V, Karch A, Schuler M, Schöffski P, Kopp HG, Bauer S, Kasper B, Lindner LH, Chemnitz JM, Crysandt M, Stein A, Steffen B, Richter S, Egerer G, Ivanyi P, Zimmermann S, Liu X, Kunitz A. Randomized Comparison of Pazopanib and Doxorubicin as First-Line Treatment in Patients With Metastatic Soft Tissue Sarcoma Age 60 Years or Older: Results of a German Intergroup Study. J Clin Oncol 2020; 38:3555-3564. [DOI: 10.1200/jco.20.00714] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Doxorubicin is a standard of care in patients with advanced, inoperable soft tissue sarcoma (STS). We tested whether pazopanib has efficacy comparable to that of doxorubicin in elderly patients with STS and offers superior tolerability for hematologic toxicity. PATIENTS AND METHODS Patients age 60 years or older without previous systemic treatment for progressive advanced or metastatic STS who had Eastern Cooperative Oncology Group performance status of 0 to 2 and adequate organ function were included. Treatment consisted of pazopanib 800 mg once per day or doxorubicin 75 mg/m2 once every 3 weeks (≤ 6 cycles) after being randomly assigned in a 2:1 ratio. Noninferiority was assumed for progression-free survival (PFS), if the upper limit of the 95% CI for the hazard ratio (HR) was less than 1.8. Neutropenia and febrile neutropenia were key secondary end points. The European Organisation for Research and Treatment of Cancer (30-item) Quality of Life Questionnaire and geriatric assessment were used to measure patient-reported outcomes. Cox regression analysis and Kaplan-Meier curves were used for analysis. RESULTS Pazopanib and doxorubicin were given to 81 and 39 patients, respectively. The median age was 71 years (range, 60-88 years). PFS was noninferior (HR, 1.00; 95% CI, 0.65 to 1.53) and the incidence of grade 4 neutropenia and febrile neutropenia favored pazopanib. Objective response rates for pazopanib and doxorubicin were 12.3% and 15.4%, respectively. Overall survival did not differ significantly between arms (HR, 1.08; 95% CI, 0.68 to 1.72; P = .735). Geriatric assessment revealed 2 or more comorbidities in 15.8% of the patients and impairment of activities of daily living in 28.3% of patients. CONCLUSION Pazopanib was noninferior to doxorubicin, rendering pazopanib a putative therapeutic option in the first-line treatment of STS in patients age 60 years or older. The distinct adverse event profile may be used to counsel patients and tailor therapy to individual needs.
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Affiliation(s)
- Viktor Grünwald
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Medical School Hannover, Hannover, Germany
- Interdisciplinary Genitourinary Oncology at the West-German Cancer Center, Clinic for Internal Medicine (Tumor Research) and Clinic for Urology, University Hospital Essen, Essen, Germany
| | - Annika Karch
- Institute for Biostatistics, Medical School Hannover, Hannover, Germany
| | | | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hans-Georg Kopp
- Robert Bosch Centrum für Tumorerkrankungen Stuttgart, Stuttgart, Germany
| | - Sebastian Bauer
- Clinic for Internal Medicine (Tumor Research), University Hospital Essen, Essen, Germany
| | - Bernd Kasper
- Sarcoma Unit, Mannheim University Medical Center, Mannheim, Germany
| | - Lars H. Lindner
- Department of Medicine III, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Jens-Marcus Chemnitz
- Community Hospital Middle Rine, Middle Rine, Germany
- Department of Hematology, Oncology, Clinical Infectious Diseases, Clinical Immunology, Hemostaseology and Medical Intensive Care, University Hospital Cologne, Cologne, Germany
| | | | - Alexander Stein
- University Hospital Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | | | - Stephan Richter
- University Hospital Carl Gustav Carus, University Cancer Center/Medical Department I, Dresden, Germany
| | | | - Philipp Ivanyi
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Medical School Hannover, Hannover, Germany
| | | | - Xiaofei Liu
- Institute for Biostatistics, Medical School Hannover, Hannover, Germany
| | - Annegret Kunitz
- Vivantes Clinic Berlin-Spandau, Berlin-Spandau, Germany
- Department of Hematology, Oncology and Tumor Immunology, University Hospital Charite, Berlin, Germany
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18
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Ferraresi V, Vari S, Rossi B, Maggi G, Giannarelli D, Persichetti A, Petrongari MG, Cercato MC, Annovazzi A, Anelli V, Pescarmona E, Baldi J, Zoccali C, Pellegrini D, Cognetti F, Biagini R. The Real-Life Journey of Elderly Patients in Soft Tissue and Bone Sarcomas: A Retrospective Analysis from a Sarcoma Referral Center. J Clin Med 2020; 9:jcm9082503. [PMID: 32759634 PMCID: PMC7465593 DOI: 10.3390/jcm9082503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/19/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022] Open
Abstract
The high complexity of multimodality treatment frequently results in undertreatment of elderly sarcoma patients, and this may be one of the factors that influence their prognosis. We describe the real-life approach to a population of patients aged over 70 with both soft tissue (STS) and bone sarcomas (BS) followed by our Sarcoma Disease Management Team from 2012 to 2017. One-hundred and twenty-three patients with a median age of 77 years (range: 70–92) were identified. STS were the most common histological subtypes (94%) and the grade was high in 79/123 patients (64%). At diagnosis, 88% of patients had localized disease (LD) and 12% were metastatic (MD). Overall, 96% of patients with LD underwent surgery, 46/54 (85%) with high grade STS patients underwent complementary radiotherapy, and 10/54 (19%) received adjuvant treatments. Twelve out of 33 patients who relapsed (36%) underwent local therapies. Seventeen (52%) and eight (24%) patients were treated with first-line and second-line medical treatments, respectively. Tolerability to systemic treatments was fairly good. Overall, 21% of the patients with advanced disease were candidates for best supportive care alone. Our case series of elderly patients with both STS and BS shows that personalized multidisciplinary treatment can nevertheless be offered to this frail population in order to control the evolution of disease.
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Affiliation(s)
- Virginia Ferraresi
- First Division of Medical Oncology, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (S.V.); (D.P.); (F.C.)
- Correspondence: ; Tel.: +39-06-52666919
| | - Sabrina Vari
- First Division of Medical Oncology, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (S.V.); (D.P.); (F.C.)
| | - Barbara Rossi
- Oncological Orthopaedics Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (B.R.); (A.P.); (J.B.); (C.Z.); (R.B.)
| | - Gabriella Maggi
- Psychology Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Diana Giannarelli
- Biostatistic Unit—Scientific Direction, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Agnese Persichetti
- Oncological Orthopaedics Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (B.R.); (A.P.); (J.B.); (C.Z.); (R.B.)
| | - Maria Grazia Petrongari
- Department of Radiation Oncology, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Maria Cecilia Cercato
- Epidemiology and Cancer Registry Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Alessio Annovazzi
- Nuclear Medicine Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Vincenzo Anelli
- Radiology and Diagnostic Imaging Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Edoardo Pescarmona
- Pathology, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Jacopo Baldi
- Oncological Orthopaedics Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (B.R.); (A.P.); (J.B.); (C.Z.); (R.B.)
| | - Carmine Zoccali
- Oncological Orthopaedics Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (B.R.); (A.P.); (J.B.); (C.Z.); (R.B.)
| | - Domenicangela Pellegrini
- First Division of Medical Oncology, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (S.V.); (D.P.); (F.C.)
| | - Francesco Cognetti
- First Division of Medical Oncology, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (S.V.); (D.P.); (F.C.)
| | - Roberto Biagini
- Oncological Orthopaedics Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (B.R.); (A.P.); (J.B.); (C.Z.); (R.B.)
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19
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Grosso F, D’Ambrosio L, Zucchetti M, Ibrahim T, Tamberi S, Matteo C, Rulli E, Comandini D, Palmerini E, Baldi GG, DeCensi A, Bergaglio M, Marra D, Marchesi E, Siri G, D’Incalci M, Grignani G. Pharmacokinetics, safety, and activity of trabectedin as first‐line treatment in elderly patients who are affected by advanced sarcoma and are unfit to receive standard chemotherapy: A phase 2 study (TR1US study) from the Italian Sarcoma Group. Cancer 2020; 126:4726-4734. [DOI: 10.1002/cncr.33120] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Federica Grosso
- Mesothelioma and Rare Cancer Unit Azienda Ospedaliera SS Antonio e Biagio General Hospital Alessandria Italy
| | - Lorenzo D’Ambrosio
- Division of Medical Oncology Candiolo Cancer Institute, FPO–IRCCS Candiolo Italy
- Department of Oncology University of Torino Orbassano Italy
| | - Massimo Zucchetti
- Department of Oncology Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milano Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS Meldola Italy
| | | | - Cristina Matteo
- Department of Oncology Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milano Italy
| | - Eliana Rulli
- Department of Oncology Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milano Italy
| | | | | | | | - Andrea DeCensi
- Division of Medical Oncology Unit EO Ospedali Galliera Genova Italy
| | | | - Domenico Marra
- Division of Medical Oncology Unit EO Ospedali Galliera Genova Italy
| | - Emanuela Marchesi
- Division of Medical Oncology Candiolo Cancer Institute, FPO–IRCCS Candiolo Italy
| | - Giacomo Siri
- Department of Mathematics University of Genoa Genova Italy
- E.O. Ospedali GallieraScientific Directorate Genova Italy
| | - Maurizio D’Incalci
- Department of Oncology Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milano Italy
| | - Giovanni Grignani
- Division of Medical Oncology Candiolo Cancer Institute, FPO–IRCCS Candiolo Italy
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20
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Martín-Broto J, Reichardt P, Jones RL, Stacchiotti S. Different approaches to advanced soft tissue sarcomas depending on treatment line, goal of therapy and histological subtype. Expert Rev Anticancer Ther 2020; 20:15-28. [PMID: 32349558 DOI: 10.1080/14737140.2020.1753510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Although rapid evolution over the past few years in advanced soft tissue sarcoma (STS) management has not been without its challenges, it has brought clarity in several areas.Areas covered: This article summarizes the proceedings of the third edition of the Soft Tissue Sarcoma: Evidence and Experience symposium held March 2019 in Madrid, Spain. An update is provided of current approaches to advanced STS management. Case studies illustrate the role of trabectedin in advanced STS management.Expert opinion: First-line treatment of advanced STS requires distinct therapeutic strategies depending on goal: tumor shrinkage or tumor control. Since all sarcoma patients benefit from active treatment irrespective of age or line of therapy, oncologists have a duty to offer active systemic therapies unless the patient is unfit for treatment or chooses to end active treatment. Beyond the first line, histology becomes increasingly relevant for treatment selection. Agents with activity in specific sarcoma subtypes have been identified. Rare tumors represent a substantial medical need requiring strong international collaboration between research groups, pharmaceutical companies, regulatory agencies, and patients to identify active drugs per subtype. Multidisciplinary care in an expert sarcoma center is the primary means of reducing morbidity and mortality in patients with sarcoma.
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Affiliation(s)
- Javier Martín-Broto
- Medical Oncology Department in University Hospital Virgen del Rocio and Institute of Biomedicine of Sevilla (IBIS), (HUVR, CSIC, University of Sevilla), Sevilla, Spain
| | - Peter Reichardt
- Department of Oncology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Robin L Jones
- Royal Marsden Hospital, Institute of Cancer Research, London, UK
| | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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21
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Subgroup analysis of older patients treated within the randomized phase 3 doxorubicin versus doxorubicin plus evofosfamide (SARC021) trial. J Geriatr Oncol 2020; 11:463-469. [DOI: 10.1016/j.jgo.2019.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 11/21/2022]
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22
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Patterns of Care and Survival in Elderly Patients With Locally Advanced Soft Tissue Sarcoma. Am J Clin Oncol 2019; 42:749-754. [DOI: 10.1097/coc.0000000000000594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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23
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Jones RL. Sarcomas and old age: few options for such a large patient population. Future Oncol 2019; 15:11-15. [DOI: 10.2217/fon-2019-0489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Although 40% of cases of soft tissue sarcoma (STS) are diagnosed in patients aged ≥65 years, this group is largely excluded from or under-represented in clinical trials and receives disproportionately less treatment than younger patients. Pooled analyses and subgroup analyses of Phase II and III randomized controlled trials of systemic therapy in advanced STS suggest the need to revisit this treatment paradigm. In various analyses, efficacy outcomes in older patients did not differ from those in younger patients or in the overall population. Available evidence supports treating elderly STS patients with similar treatment as that for younger patients. However, as some treatments are less well tolerated in older patients, safety must be considered when selecting treatment. As physiological rather than chronological age is a more appropriate criterion for treatment selection, geriatric assessment has a central role in trial design and routine clinical practice. The majority of evidence for the efficacy and safety of systemic therapy in elderly, advanced STS patients has been generated with trabectedin, which is the only agent approved for first-line use in patients unsuited to receive doxorubicin-based regimens.
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Affiliation(s)
- Robin L Jones
- Sarcoma Unit, Royal Marsden Hospital & Institute of Cancer Research, London, UK
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24
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Optimising Clinical Trial Design in Older Cancer Patients. Geriatrics (Basel) 2018; 3:geriatrics3030034. [PMID: 31011072 PMCID: PMC6319227 DOI: 10.3390/geriatrics3030034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/13/2018] [Accepted: 06/21/2018] [Indexed: 12/04/2022] Open
Abstract
Cancer is predominantly a disease of older patients, with over half of those aged over 65 years of age being diagnosed with cancer at some stage. Despite comprising a significant proportion of the patients that we see in clinical practice, there is a lack of representation of older patients in cancer clinical trials. This is mainly due to restrictive trial inclusion criteria that prevent older patients from participating. Also, trial endpoints, such as overall survival, may not represent the most important and most meaningful endpoints for older patients. The latter may place more significance on quality of life and other outcomes such as functional independence. Baseline assessment using Comprehensive Geriatric Assessment, may provide a better framework for quantifying patient outcomes for varying degrees of fitness or frailty. This short communication makes the case for more age appropriate endpoints, such as quality of life, toxicity and functional independence, and that novel trial designs are necessary to inform evidence-based care of older cancer patients.
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