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  • Review Article
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Using biology to guide the treatment of sarcomas and aggressive connective-tissue tumours

Nature Reviews Clinical Oncology volume 15, pages 443–458 (2018)Cite this article

Subjects

Abstract

Sarcomas are a heterogeneous group of malignancies that arise from cells of a mesenchymal origin. Surgery forms the mainstay of the treatment of most patients with localized sarcoma and might be followed or preceded by chemotherapy and/or radiotherapy. In the metastatic setting, systemic treatments tend to improve survival and control symptoms. However, the adverse events and sometimes disappointing outcomes associated with these empirical approaches to treatment indicate a need for new approaches. The advent of next-generation sequencing (NGS) has enabled more targeted treatment of many malignancies based on the presence of specific alterations. NGS analyses of sarcomas have revealed the presence of many alterations that can be targeted using therapies that are already used in patients with other forms of cancer. In this Review, we describe the genomic alterations considered to define specific nosological subgroups of sarcoma and whose contribution to oncogenesis provides a biological rationale for the use of a specific targeted therapy. We also report several less successful examples that should guide researchers and clinicians to better define the extent to which the identification of driver molecular alterations should influence the development of novel treatments.

Key points

  • Certain genomic alterations define specific nosological subgroups of sarcoma, and their contribution to oncogenesis provides a biological rationale for the use of a specific targeted therapy.

  • Receptor tyrosine-kinase activation in gastrointestinal stromal tumours (GISTs) is a paradigmatic model in which the genomic characterization of a tumour provides information on diagnosis, prognosis, and response to treatment and enables improved patient outcomes.

  • Translocation-related sarcomas constitute a classical subgroup of sarcoma; however, the translation of a specific fusion protein into an effective targeted treatment has sometimes proved difficult to achieve.

  • Many therapeutic strategies are under development in an attempt to target other mechanisms of carcinogenesis, such as inactivation of tumour suppressor genes, gene amplification, or epigenetic dysregulation.

  • Research strategies should attempt to increase the use of genomic screening and integrate analyses of multiple genomic events to guide treatment and continue to improve the outcomes of patients with sarcoma.

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Acknowledgements

The authors gratefully acknowledge financial support from the Association DAM’s, Ensemble contre Le GIST, Eurosarc (FP7-278742), Info Sarcomes, InterSARC (INCA), la Fondation ARC, LabEx DEVweCAN (ANR-10-LABX-0061), Ligue de L’Ain contre le Cancer, Lyon Integrative Cancer Research Program (Lyric) (DGOS-INCa-4664), NetSARC (INCA), and RREPS (INCA).

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  1. Department of Medical Oncology, Centre Leon Berard, Lyon, France

    Armelle Dufresne, Mehdi Brahmi & Jean-Yves Blay

  2. Department of Pathology, Centre Leon Berard, Lyon, France

    Marie Karanian

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Dufresne, A., Brahmi, M., Karanian, M. et al. Using biology to guide the treatment of sarcomas and aggressive connective-tissue tumours. Nat Rev Clin Oncol 15, 443–458 (2018). https://doi.org/10.1038/s41571-018-0012-4

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