Elderly Patients Are Underrepresented in Trials For Soft Tissue Sarcoma

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Although approximately half of STS diagnoses are from patients older than 65, the median age of trial participants is lower.
Although approximately half of STS diagnoses are from patients older than 65, the median age of trial participants is lower.

Elderly patients with soft tissue sarcoma (STS) have worst outcomes after first-line chemotherapy compared to younger patients, but are severely underrepresented in clinical studies, according to a study published in The Oncologist.

Although approximately half of STS diagnoses are from patients older than 65, the median age of participants in STS studies is between 45 and 60; outcomes of elderly patients after first-line chemotherapy require further evaluation.

For this study, researchers accessed the European Organization for Research and Treatment of Cancer (EORTC) Soft Tissue and Bone Sarcoma Group database to review 12 clinical trials studying the effects of first-line chemotherapy among 2810 patients with STS.

Only 12.4% (348) of study participants were 65 years and older, and approximately 90% had a favorable performance status (0 or 1).

The most common STS histological subtype was leiomyosarcoma, and 52% (181) and 18% (63) of patients had lung and liver metastases, respectively. First-line therapies studied included doxorubicin, doxorubicin plus ifosfamide, epirubicin, trabectedin, and ifosfamide.

The overall response rate (RR) among elderly patients was 14.9% (52), median progression-free survival (PFS) was 3.5 months, and median overall survival (OS) was 10.8 months.

Among patients younger than 65 years, the overall RR was 20.3% (501), median PFS was 4.3 months, and median OS was 12.4 months.

The authors concluded that “in light of the aging population, there is an increasing need to design studies that specifically evaluate treatments in elderly patients, not only those with favorable characteristics. The results of this analysis can help in the design of future trials, which should incorporate geriatric tools to stratify patients and assess risk and include health-related quality of life assessments as endpoints.”

Reference

Younger E, Litiere S, Le Cesne A, et al. Outcomes of elderly patients with advanced soft tissue sarcoma treated with first-line chemotherapy: a pooled analysis of 12 EORTC Soft Tissue and Bone Sarcoma Group Trials[published online April 12, 2018]. Oncologist. doi: 10.1634/theoncologist.2017-0598

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