Chemotherapy in adult soft tissue sarcoma

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Date: October-December 2009
From: Indian Journal of Cancer(Vol. 46, Issue 4)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Report
Length: 8,930 words

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Byline: A. Jain, K. Sajeevan, K. Babu, K. Lakshmaiah

Soft tissue sarcomas (STSs) are rare and histologically diverse neoplasms. Recent results of various meta-analyses and development of newer drugs have changed the medical management of soft tissue sarcoma. This review gives an outline of chemotherapy and the newer targeted therapies for the same. We have carried out an extensive search in PubMed, Medline for almost all relevant articles concerning chemotherapy of soft tissue sarcoma. The available data from the literature is mainly composed of the most recent reviews, meta-analyses, phase II, and randomized phase III trials published in various peer reviewed journals and various international conferences. The role of neoadjuvant and adjuvant chemotherapy has been found to be controversial. The recent meta-analysis for adjuvant therapy in STSs has shown an increase in the overall survival with combination of ifosfamide and adriamycin. In locally advanced and metastatic STSs, single agent adriamycin remains the basic standard of medication. The combination of ifosfamide and adriamycin may also be used for rapid symptom relief and in patients planned for curative resection for metastases. Newer combinations of docetaxel and gemcitabine appear promising in selected subgroups, especially in leiomyosarcoma and malignant fibrous histiocytoma. Some recent developments include the European Union's approval of trabectedin for advanced STSs patients who had progressed on adriamycin and ifosfamide therapy. The future of mTOR inhibitors, insulin like growth factor receptor inhibitors and anti-angiogenic drugs appear quite promising. Newer methodologies such as, Bayesian adaptive randomization and inclusion of newer end points like progression-free rate, time of progression rate, and tumor growth rate will improve the results of sarcoma trials. At the end of each section we have also presented recommendations from FNx01European Society of Medical Oncology and FNx08National Comprehensive Cancer Network guidelines v.1.2009 for better correlation with the present literature.

Introduction

Soft tissue sarcomas (STSs) comprise of a group of relatively rare, anatomically and histologically diverse neoplasms. Embryologically these tumors are derived from tissues arising from the mesodermal and ectodermal layer. They account for 1% of adult malignancies and 15% of pediatric malignancies. The incidence of STSs in USA is approximately 8300 new cases annually. These tumors are rare and histologically diverse, which makes it difficult to develop specific therapies for these specific tumor types.[sup] [1]

We carried forth an extensive literary search in the Pub Med and Medline of almost all relevant articles concerning chemotherapy of soft tissue sarcoma. The available data from the literature is mainly composed of the most recent reviews, meta-analyses, and phase II and randomized phase III trials published in various peer reviewed journals and various international meetings. This review aims to discuss the recent standard chemotherapy management in non GIST (gastrointestinal stromal tumors) STSs and controversies related to neoadjuvant, adjuvant, and palliative chemotherapy in STSs. This review also discusses the newer cytotoxic chemotherapy combinations and targeted therapies that will increase the footholds of the medical oncologist in the management of STSs in the near future. At the end of each section we have also presented recommendations...

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Gale Document Number: GALE|A208077244