Adjuvant chemotherapy in soft tissue sarcomas…Conflicts, consensus, and controversies

Jyoti Bajpai; Deepa Susan

doi:10.4103/2278-330X.179687

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SARCOMA Review Article

05 (

); 15-19

doi:

10.4103/2278-330X.179687

Adjuvant chemotherapy in soft tissue sarcomas…Conflicts, consensus, and controversies

Jyoti Bajpai^1,, Deepa Susan¹

1 Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra

*Corresponding author: Dr. Jyoti Bajpai. dr_jyotibajpai@yahoo.co.in

Published: 2020-12-30

MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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Abstract

Soft tissue sarcomas (STSs) are an uncommon and diverse group of more than 50 mesenchymal malignancies. Each of these histologic subtypes represents a unique disease with distinct biologic behavior and varying sensitivity to chemotherapy. The judicious use of adjuvant/neoadjuvant chemotherapy along with surgery and radiation in the treatment of localized STS has a role in improving patient outcomes by decreasing local and distant recurrences. There is evidence that the use of adjuvant chemotherapy to a mixed cohort of chemo sensitive and insensitive sarcoma subtypes results in limited benefit. Therefore, it is of paramount importance to identify the subpopulation with high metastatic potential and to identify effective histology-specific treatment options to these patients. Present perspective, will focus on the rationale for adjuvant chemotherapy in sarcoma, with emphasis on the histology driven chemotherapy. It will outline key therapeutic opportunities and hurdles in adjuvant medical treatment of sarcoma, focusing on specific subtypes that are on the verge of new breakthroughs, as well as those in which promise has not lived up to expectations.

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References

Clark MA, Fisher C, Judson I, Thomas JM. Soft tissue sarcomas in adults. N Engl J Med 2005;353:701 11.
Antman KH. Adjuvant therapy of sarcomas of soft tissue. Semin Oncol 1997;24:556 60.
Adjuvant chemotherapy for localised resectable soft tissue sarcoma of adults: Meta analysis of individual data. Sarcoma Meta analysis Collaboration. Lancet 1997;350:1647 54.
Brodowicz T, Schwameis E, Widder J, Amann G, Wiltschke C, Dominkus M, et al. Intensified adjuvant IFADIC chemotherapy for adult soft tissue sarcoma: A prospective randomized feasibility trial. Sarcoma 2000;4:151 60.
Frustaci S, Gherlinzoni F, De Paoli A, Bonetti M, Azzarelli A, Comandone A, et al. Adjuvant chemotherapy for adult soft tissue sarcomas of the extremities and girdles: Results of the Italian randomized cooperative trial. J Clin Oncol 2001;19:1238 47.
Frustaci S, De Paoli A, Bidoli E, La Mura N, Berretta M, Buonadonna A, et al. Ifosfamide in the adjuvant therapy of soft tissue sarcomas. Oncology 2003;65 Suppl 2:80 4.
Petrioli R, Coratti A, Correale P, D’Aniello C, Grimaldi L, Tanzini G, et al. Adjuvant epirubicin with or without ifosfamide for adult soft tissue sarcoma. Am J Clin Oncol 2002;25:468 73.
Woll PJ, Reichardt P, Le Cesne A, Bonvalot S, Azzarelli A, Hoekstra HJ, et al. Adjuvant chemotherapy with doxorubicin, ifosfamide, and lenograstim for resected soft tissue sarcoma (EORTC 62931): A multicentre randomised controlled trial. Lancet Oncol 2012;13:1045 54.
Pervaiz N, Colterjohn N, Farrokhyar F, Tozer R, Figueredo A, Ghert M. A systematic meta analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft tissue sarcoma. Cancer 2008;113:573 81.
Le Cesne A, Ouali M, Leahy MG, Santoro A, Hoekstra HJ, Hohenberger P Doxorubicin based adjuvant chemotherapy in soft tissue sarcoma: Pooled analysis of two STBSG EORTC phase III clinical trials. Ann Oncol. 2014 Dec; 25:2425 32
Blay JY, Le Cesne A. Adjuvant chemotherapy in localized soft tissue sarcomas: Still not proven. Oncologist 2009;14:1013 20.
Eilber FC, Eilber FR, Eckardt J, Rosen G, Riedel E, Maki RG, et al. The impact of chemotherapy on the survival of patients with high grade primary extremity liposarcoma. Ann Surg 2004;240:686 95.
Ferrari A, Gronchi A, Casanova M, Meazza C, Gandola L, Collini P, et al. Synovial sarcoma: A retrospective analysis of 271 patients of all ages treated at a single institution. Cancer 2004;101:627 34.
Cormier JN, Huang X, Xing Y, Thall PF, Wang X, Benjamin RS, et al. Cohort analysis of patients with localized, high risk, extremity soft tissue sarcoma treated at two cancer centers: Chemotherapy associated outcomes. J Clin Oncol 2004;22:4567 74.
Eilber FC, Brennan MF, Eilber FR, Eckardt JJ, Grobmyer SR, Riedel E, et al. Chemotherapy is associated with improved survival in adult patients with primary extremity synovial sarcoma. Ann Surg 2007;246:105 13.
Casali PG, Blay JY, ESMO/CONTICANET/EUROBONET Consensus Panel of experts. Soft tissue sarcomas: ESMO Clinical practice guidelines for diagnosis, treatment and follow up. Ann Oncol 2010;21 Suppl 5:v198 203.
Schuetze SM, Patel S. Should patients with high risk soft tissue sarcoma receive adjuvant chemotherapy? Oncologist 2009;14:1003 12.

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[1] Clark MA, Fisher C, Judson I, Thomas JM. Soft tissue sarcomas in adults. N Engl J Med 2005;353:701 11.

[2] Antman KH. Adjuvant therapy of sarcomas of soft tissue. Semin Oncol 1997;24:556 60.

[3] Adjuvant chemotherapy for localised resectable soft tissue sarcoma of adults: Meta analysis of individual data. Sarcoma Meta analysis Collaboration. Lancet 1997;350:1647 54.

[4] Brodowicz T, Schwameis E, Widder J, Amann G, Wiltschke C, Dominkus M, et al. Intensified adjuvant IFADIC chemotherapy for adult soft tissue sarcoma: A prospective randomized feasibility trial. Sarcoma 2000;4:151 60.

[5] Frustaci S, Gherlinzoni F, De Paoli A, Bonetti M, Azzarelli A, Comandone A, et al. Adjuvant chemotherapy for adult soft tissue sarcomas of the extremities and girdles: Results of the Italian randomized cooperative trial. J Clin Oncol 2001;19:1238 47.

[6] Frustaci S, De Paoli A, Bidoli E, La Mura N, Berretta M, Buonadonna A, et al. Ifosfamide in the adjuvant therapy of soft tissue sarcomas. Oncology 2003;65 Suppl 2:80 4.

[7] Petrioli R, Coratti A, Correale P, D’Aniello C, Grimaldi L, Tanzini G, et al. Adjuvant epirubicin with or without ifosfamide for adult soft tissue sarcoma. Am J Clin Oncol 2002;25:468 73.

[8] Woll PJ, Reichardt P, Le Cesne A, Bonvalot S, Azzarelli A, Hoekstra HJ, et al. Adjuvant chemotherapy with doxorubicin, ifosfamide, and lenograstim for resected soft tissue sarcoma (EORTC 62931): A multicentre randomised controlled trial. Lancet Oncol 2012;13:1045 54.

[9] Pervaiz N, Colterjohn N, Farrokhyar F, Tozer R, Figueredo A, Ghert M. A systematic meta analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft tissue sarcoma. Cancer 2008;113:573 81.

[10] Le Cesne A, Ouali M, Leahy MG, Santoro A, Hoekstra HJ, Hohenberger P Doxorubicin based adjuvant chemotherapy in soft tissue sarcoma: Pooled analysis of two STBSG EORTC phase III clinical trials. Ann Oncol. 2014 Dec; 25:2425 32

[11] Blay JY, Le Cesne A. Adjuvant chemotherapy in localized soft tissue sarcomas: Still not proven. Oncologist 2009;14:1013 20.

[12] Eilber FC, Eilber FR, Eckardt J, Rosen G, Riedel E, Maki RG, et al. The impact of chemotherapy on the survival of patients with high grade primary extremity liposarcoma. Ann Surg 2004;240:686 95.

[13] Ferrari A, Gronchi A, Casanova M, Meazza C, Gandola L, Collini P, et al. Synovial sarcoma: A retrospective analysis of 271 patients of all ages treated at a single institution. Cancer 2004;101:627 34.

[14] Cormier JN, Huang X, Xing Y, Thall PF, Wang X, Benjamin RS, et al. Cohort analysis of patients with localized, high risk, extremity soft tissue sarcoma treated at two cancer centers: Chemotherapy associated outcomes. J Clin Oncol 2004;22:4567 74.

[15] Eilber FC, Brennan MF, Eilber FR, Eckardt JJ, Grobmyer SR, Riedel E, et al. Chemotherapy is associated with improved survival in adult patients with primary extremity synovial sarcoma. Ann Surg 2007;246:105 13.

[16] Casali PG, Blay JY, ESMO/CONTICANET/EUROBONET Consensus Panel of experts. Soft tissue sarcomas: ESMO Clinical practice guidelines for diagnosis, treatment and follow up. Ann Oncol 2010;21 Suppl 5:v198 203.

[17] Schuetze SM, Patel S. Should patients with high risk soft tissue sarcoma receive adjuvant chemotherapy? Oncologist 2009;14:1003 12.

Adjuvant chemotherapy in soft tissue sarcomas…Conflicts, consensus, and controversies

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Abstract

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