Histology-tailored neoadjuvant chemotherapy (HT) does not appear to be associated with better disease-free survival (DFS) or overall survival (OS) than standard anthracycline plus ifosfamide neoadjuvant chemotherapy (A+I) in 5 high-risk soft tissue sarcoma (STS) subtypes of the extremities or trunk wall, according to European researchers.

The final results from a randomized trial with Italian, Spanish, French, and Polish sarcoma groups has found A+I should remain the regimen of choice whenever neoadjuvant chemotherapy is considered across 5 histologic subtypes (high-grade myxoid liposarcoma [HG-MLPS], leiomyosarcoma [LMS], synovial sarcoma [SS], malignant peripheral nerve sheath tumor [MPNST], and undifferentiated pleomorphic sarcoma [UPS]).

In this randomized, open-label, phase 3 trial, all the patients had localized high-risk STS (grade 3; size, 5 cm or greater) of an extremity or trunk wall and were treated between May 2011 and May 2016. These 5 histologic subtypes account for 80% of all high-risk STS of the extremities or trunk wall. In this current investigation, 287 patients were randomly assigned in a 1:1 ratio to receive 3 cycles of A+I or HT. Among the 287 patients, 97.9% underwent surgery (281 individuals). The cohort included 177 men and 110 women (ClinicalTrials.gov Identifier: NCT01710176).

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The HT regimens included trabectedin in patients with HG-MLPS and gemcitabine plus dacarbazine in patients with LMS. In patients with SS, the HT regimen was high-dose prolonged-infusion ifosfamide and in patients with MPNST, the HT regimen was etoposide plus ifosfamide. Patients with UPS received gemcitabine plus docetaxel as their HT regimen.


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Among the 240 evaluable patients, there were no complete responses and nearly 10% had a partial response (23 individuals). The researchers found a non-statistically significant difference in 5-year DFS (0.55 vs 0.47, respectively) and a statistically significant difference in OS in favor of A+I (0.76 vs 0.66, respectively). The study showed no toxic deaths in either group.

Reference

Gronchi A, Palmerini E, Quagliuolo V, et al. Neoadjuvant Chemotherapy in high-risk soft tissue sarcomas: Final results of a randomized trial from Italian (ISG), Spanish (GEIS), French (FSG), and Polish (PSG) Sarcoma Groups (published online May 18, 2020). J Clin Oncol. doi: 10.1200/JCO.19.03289

This article originally appeared on Cancer Therapy Advisor