Improved Survival from Neoadjuvant Chemotherapy for Soft-Tissue Sarcoma

Neoadjuvant chemotherapy with epirubicin plus ifosfamide improves outcomes in patients with soft tissue sarcoma of the trunk or extremities who are at high-risk of recurrence, according to a study presented at the European Society for Medical Oncology 2016 Congress in Copenhagen, Denmark (October 7-11, 2016).

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For the study, researchers led by Alessandro Gronchi, MD, chair of the sarcoma surgery at the National Cancer Institute (Milan, Italy), compared the effect of tailoring chemotherapy regimens to histology with neoadjuvant chemotherapy on recurrence risk.

Researchers sampled 287 patients with high-risk soft tissue sarcoma of the trunk or extremities. Patients were randomized either to three cycles of epirubicin plus ifosfamide or three cycles of one of five histologically-tailored regimens. The regimens included gemcitabine plus docetaxel in undifferentiated pleomorphic sarcoma; trabectedin in high-grade myxoid liposarcoma; high-dose prolonged-infusion ifosfamide in synovial sarcoma; etoposide plus ifosfamide in malignant peripheral nerve sheath tumors; or gemcitabine plus dacarbazine in leiomyosarcoma.

Overall, that neoadjuvant anthracycline plus ifosfamide improved the prognosis of patients with soft tissue sarcoma of the trunk or extremities by 20%.    

Patients randomized to epirubicin plus ifosfamide showed a significantly higher probability of relapse-free survival after 46 months than patients randomized to histologically-tailored regimens (0.62 vs. 0.38, p=0.004), as well as a higher probability of overall survival (0.89 vs 0.64, p=0.033).

The study did not show any benefit from histologically-tailored regimens, but patients with high-grade myxoid liposarcoma treated with trabectedin had similar relapse-free and overall survival compared with those patients treated with the epirubicin plus ifosfamide. Dr Gronchi indicated that further research would be needed to see if the two treatments have any significant difference in outcomes.

“As it was not apparent that the histology-driven therapy could have been associated with any detrimental effect per se, the main interest of these findings (if confirmed by a longer follow-up) is proof that using a neo-adjuvant therapy in patients affected by high risk soft tissue sarcoma of the extremities or trunk wall, is associated with a clear-cut overall and relapse-free survival  advantage, as compared with any other available strategy, including no treatment,” concluded Dr Gronchi.