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Adjuvant chemotherapy in 2011 for patients with soft-tissue sarcoma

Abstract

The mainstay of treatment for adults with soft-tissue sarcomas is wide surgical excision. Half of all patients with adequate local control of high-grade sarcomas develop distant metastases and, despite additional treatment, ultimately die from their disease. This daunting reality has resulted in a three-decade research effort to assess the efficacy of adjuvant therapy for adult soft-tissue sarcomas. The multitude of histopathological subtypes, each with its own biology and clinical behavior, and the rarity of adult soft-tissue sarcomas as a whole greatly complicate such an assessment. This Perspectives article examines data that support or refute the use of adjuvant chemotherapy in the treatment of soft-tissue sarcomas.

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Figure 1: Adjuvant chemotherapy in soft-tissue sarcomas.

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References

  1. Omura, G. A. et al. A randomized clinical trial of adjuvant adriamycin in uterine sarcomas: a Gynecologic Oncology Group Study. J. Clin. Oncol. 3, 1240–1245 (1985).

    Article  CAS  PubMed  Google Scholar 

  2. Antman, K. et al. Preliminary results of a randomized trial of adjuvant doxorubicin for sarcomas: lack of apparent difference between treatment groups. J. Clin. Oncol. 2, 601–608 (1984).

    Article  CAS  PubMed  Google Scholar 

  3. Elias, A. D. & Antman, K. H. Adjuvant chemotherapy for soft-tissue sarcoma: a critical appraisal. Semin. Surg. Oncol. 4, 59–65 (1988).

    Article  CAS  PubMed  Google Scholar 

  4. Elias, A. D. & Antman, K. H. Adjuvant chemotherapy for soft tissue sarcoma: an approach in search of an effective regimen. Semin. Oncol. 16, 305–311 (1989).

    CAS  PubMed  Google Scholar 

  5. Mertens, W. C. & Bramwell, V. H. Adjuvant chemotherapy in the treatment of soft-tissue sarcoma. Clin. Orthop. Relat. Res. 289, 81–93 (1993).

    Google Scholar 

  6. Sarcoma Meta-analysis Collaboration. Adjuvant chemotherapy for localised resectable soft tissue sarcoma in adults. Sarcoma Meta-analysis Collaboration (SMAC). Cochrane Database Syst. Rev. Issue 4 Art. No. CD001419. doi:10.1002/14651858.CD001419 (2000).

  7. Sarcoma Meta-analysis Collaboration. Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. Sarcoma Meta-analysis Collaboration. Lancet 350, 1647–1654 (1997).

  8. Verweij, J. & Seynaeve, C. The reason for confining the use of adjuvant chemotherapy in soft tissue sarcoma to the investigational setting. Semin. Radiat. Oncol. 9, 352–359 (1999).

    Article  CAS  PubMed  Google Scholar 

  9. Antman, K. H. Adjuvant therapy of sarcomas of soft tissue. Semin. Oncol. 24, 556–560 (1997).

    CAS  PubMed  Google Scholar 

  10. Judson, I. Adjuvant chemotherapy of soft tissue sarcoma-current status. Sarcoma 4, 149–150 (2000).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Bramwell, V. H. Adjuvant chemotherapy for adult soft tissue sarcoma: Is there a standard of care? J. Clin. Oncol. 19, 1235–1237 (2001).

    Article  CAS  PubMed  Google Scholar 

  12. Figueredo, A. et al. Adjuvant chemotherapy following complete resection of soft tissue sarcoma in adults: a clinical practice guideline. Sarcoma 6, 5–18 (2002).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Casali, P. G. & Picci, P. Adjuvant chemotherapy for soft tissue sarcoma. Curr. Opin. Oncol. 17, 361–365 (2005).

    Article  CAS  PubMed  Google Scholar 

  14. Bramwell, V. H. Controversies in surgical oncology: routine anthracycline-based adjuvant chemotherapy for stage III extremity soft tissue sarcoma. Ann. Surg. Oncol. 14, 1254–1256 (2007).

    Article  PubMed  Google Scholar 

  15. Blay, J. Y. & Le Cesne, A. Adjuvant chemotherapy in localized soft tissue sarcomas: still not proven. Oncologist 14, 1013–1020 (2009).

    Article  PubMed  Google Scholar 

  16. Schuetze, S. M. & Patel, S. Should patients with high-risk soft tissue sarcoma receive adjuvant chemotherapy? Oncologist 14, 1003–1012 (2009).

    Article  CAS  PubMed  Google Scholar 

  17. O'Sullivan, B. et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet 359, 2235–2241 (2002).

    Article  PubMed  Google Scholar 

  18. Yang, J. C. et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J. Clin. Oncol. 16, 197–203 (1998).

    Article  CAS  PubMed  Google Scholar 

  19. Pisters, P. W., O'Sullivan, B., Maki, R. G. Evidence-based recommendations for local therapy for soft tissue sarcomas. J. Clin. Oncol. 25, 1003–1008 (2007).

    Article  PubMed  Google Scholar 

  20. Greene, F., Page, D. L., Fleming, I. D., Fritz, A. G., Balch, C. M., Haller DM, and Morrow M (eds). AJCC Cancer Staging Manual, Sixth Edition (Springer, New York, 2002).

    Google Scholar 

  21. Borden, E. C. et al. Randomized comparison of three adriamycin regimens for metastatic soft tissue sarcomas. J. Clin. Oncol. 5, 840–850 (1987).

    Article  CAS  PubMed  Google Scholar 

  22. Mouridsen, H. T. et al. Adriamycin versus epirubicin in advanced soft tissue sarcomas. A randomized phase II/phase III study of the EORTC Soft Tissue and Bone Sarcoma Group. Eur. J. Cancer Clin. Oncol. 23, 1477–1483 (1987).

    Article  CAS  PubMed  Google Scholar 

  23. Gottlieb, J. A. et al. Role of DTIC (NSC-45388) in the chemotherapy of sarcomas. Cancer Treat. Rep. 60, 199–203 (1976).

    CAS  PubMed  Google Scholar 

  24. Fidias, P., Demetri, G. D. & Harmon, D. C. Navelbine shows activity in previously treated sarcoma patients: phase II results from MGH/Dana-Farber/Partners CancerCare Study [abstract]. Proc. Am. Soc. Clin. Oncol. 17, a1977 (1998).

    Google Scholar 

  25. Patel, S. R. et al. Preliminary results of a two-arm phase 2 trial of gemcitabine in patients with gastroinstestinal leiomyosarcomas and other soft-tissue sarcomas (STS) [abstract]. Sarcoma 3, 56 (1999).

    Google Scholar 

  26. van Hoesel, Q. G. et al. Phase II study with docetaxel (Taxotere) in advanced soft tissue sarcomas of the adult. EORTC Soft Tissue and Bone Sarcoma Group. Ann. Oncol. 5, 539–542 (1994).

    Article  CAS  PubMed  Google Scholar 

  27. Edmonson, J. H. et al. Phase II study of docetaxel in advanced soft tissue sarcomas. Am. J. Clin. Oncol. 19, 574–576 (1996).

    Article  CAS  PubMed  Google Scholar 

  28. Verweij, J. et al. Randomized phase II study of docetaxel versus doxorubicin in first- and second-line chemotherapy for locally advanced or metastatic soft tissue sarcomas in adults: a study of the european organization for research and treatment of cancer soft tissue and bone sarcoma group. J. Clin. Oncol. 18, 2081–2086 (2000).

    Article  CAS  PubMed  Google Scholar 

  29. Gian, V. G., Johnson, T. J., Marsh, R. W., Schuhmacher, C. & Lynch, J. W. A phase II trial of paclitaxel in the treatment of recurrent or metastatic soft tissue sarcomas or bone sarcomas. J. Exp. Ther. Oncol. 1, 186–190 (1996).

    CAS  PubMed  Google Scholar 

  30. Patel, S. R. et al. Phase II study of paclitaxel in patients with soft tissue sarcomas. Sarcoma 1, 95–97 (1997).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Loehrer, P. J. Sr. et al. Ifosfamide plus doxorubicin in metastatic adult sarcomas: a multi-institutional phase II trial. J. Clin. Oncol. 7, 1655–1659 (1989).

    Article  PubMed  Google Scholar 

  32. Edmonson, J. H. et al. Randomized comparison of doxorubicin alone versus ifosfamide plus doxorubicin or mitomycin, doxorubicin, and cisplatin against advanced soft tissue sarcomas. J. Clin. Oncol. 11, 1269–1275 (1993).

    Article  CAS  PubMed  Google Scholar 

  33. Santoro, A. et al. Doxorubicin versus CYVADIC versus doxorubicin plus ifosfamide in first-line treatment of advanced soft tissue sarcomas: a randomized study of the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group. J. Clin. Oncol. 13, 1537–1545 (1995).

    Article  CAS  PubMed  Google Scholar 

  34. Omura, G. A. et al. A randomized study of adriamycin with and without dimethyl triazenoimidazole carboxamide in advanced uterine sarcomas. Cancer 52, 626–632 (1983).

    Article  CAS  PubMed  Google Scholar 

  35. Hensley, M. L. et al. Gemcitabine and docetaxel in patients with unresectable leiomyosarcoma: results of a phase II trial. J. Clin. Oncol. 20, 2824–2831 (2002).

    Article  CAS  PubMed  Google Scholar 

  36. Maki, R. G. et al. Randomized phase II study of gemcitabine and docetaxel compared with gemcitabine alone in patients with metastatic soft tissue sarcomas: results of sarcoma alliance for research through collaboration study 002 [corrected]. J. Clin. Oncol. 25, 2755–2763 (2007).

    Article  CAS  PubMed  Google Scholar 

  37. Brodowicz, T. et al. Intensified adjuvant IFADIC chemotherapy for adult soft tissue sarcoma: a prospective randomized feasibility trial. Sarcoma 4, 151–160 (2000).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Fakhrai, N. et al. Intensified adjuvant IFADIC chemotherapy in combination with radiotherapy versus radiotherapy alone for soft tissue sarcoma: long-term follow-up of a prospective randomized feasibility trial. Wien. Klin. Wochenschr. 122, 614–619 (2010).

    Article  CAS  PubMed  Google Scholar 

  39. Petrioli, R. et al. Adjuvant epirubicin with or without ifosfamide for adult soft-tissue sarcoma. Am. J. Clin. Oncol. 25, 468–473 (2002).

    Article  PubMed  Google Scholar 

  40. Frustaci, S. et al. Adjuvant chemotherapy for adult soft tissue sarcomas of the extremities and girdles: results of the Italian randomized cooperative trial. J. Clin. Oncol. 19, 1238–1247 (2001).

    Article  CAS  PubMed  Google Scholar 

  41. Frustaci, S. et al. Ifosfamide in the adjuvant therapy of soft tissue sarcomas. Oncology 65, 80–84 (2003).

    Article  CAS  PubMed  Google Scholar 

  42. O'Connor, J. M., Chacón, M., Petracci, F. E. & Chacón, R. D. Adjuvant chemotherapy in soft tissue sarcoma (STS): A meta-analysis of published data [abstract]. J. Clin. Oncol. 26 (15 Suppl.), a10526 (2008).

    Article  Google Scholar 

  43. Woll, P. J. et al., Adjuvant chemotherapy (CT) with doxorubicin and ifosfamide in resected soft tissue sarcoma (STS): interim analysis of a randomised phase III trial [abstract]. J. Clin. Oncol. 25 (18 Suppl.), a10008 (2007).

    Google Scholar 

  44. Afonso, S. L., Ramos, L. A., Viani, G. A., Stefano, E. & Afonso, V. Improvement in the survival for adult soft tissue sarcoma with adjuvant anthracycline chemotherapy combination: a meta-analysis and metaregression [abstract]. J. Clin. Oncol. 28 (15 Suppl.), a10024 (2010).

    Google Scholar 

  45. Pervaiz, N. et al. A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma. Cancer 113, 573–581 (2008).

    Article  PubMed  Google Scholar 

  46. Gortzak, E. et al. A randomised phase II study on neo-adjuvant chemotherapy for 'high-risk' adult soft-tissue sarcoma. Eur. J. Cancer 37, 1096–1103 (2001).

    Article  CAS  PubMed  Google Scholar 

  47. Fleming, T. R. Clinical trials: discerning hype from substance. Ann. Intern. Med. 153, 400–406 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  48. Le Cesne, A. et al., The end of adjuvant chemotherapy (adCT) era with doxorubicin-based regimen in resected high-grade soft tissue sarcoma (STS): Pooled analysis of the two STBSG-EORTC phase III clinical trials [abstract]. J. Clin. Oncol. 26 (15 Suppl.), a10525 (2008).

    Article  Google Scholar 

  49. Engstrom, P. F. et al. NCCN Clinical Practice Guidelines in Oncology: colon cancer. J. Natl Compr. Canc. Netw. 7, 778–831 (2009).

    Article  PubMed  Google Scholar 

  50. Carlson, R. W. et al. Breast cancer. Clinical practice guidelines in oncology. J. Natl Compr. Canc. Netw. 7, 122–192 (2009).

    Article  CAS  PubMed  Google Scholar 

  51. Montie, J. E. et al. Bladder cancer. Clinical practice guidelines in oncology. J. Natl Compr. Canc. Netw. 3, 19–34 (2005).

    Google Scholar 

  52. Ychou, M. et al. A randomized phase III study comparing adjuvant 5-fluorouracil/folinic acid with FOLFIRI in patients following complete resection of liver metastases from colorectal cancer. Ann. Oncol. 20, 1964–1970 (2009).

    Article  CAS  PubMed  Google Scholar 

  53. Bramwell, V. H., Anderson, D. & Charette, M. L. Doxorubicin-based chemotherapy for the palliative treatment of adult patients with locally advanced or metastatic soft tissue sarcoma. Cochrane Database Syst. Rev., CD003293 (2003).

  54. Wilson, R. E. et al. Doxorubicin chemotherapy in the treatment of soft-tissue sarcoma. Combined results of two randomized trials. Arch. Surg. 121, 1354–1359 (1986).

    Article  CAS  PubMed  Google Scholar 

  55. Verschraegen, C. F. et al. A phase II, randomized, controlled trial of palifosfamide plus doxorubicin versus doxorubicin in patients with soft tissue sarcoma (PICASSO). J. Clin. Oncol. 28 (15 Suppl.), a10004 (2010).

    Article  Google Scholar 

  56. US National Library of Medicine. Clinicaltrials.gov [online]. (2010).

  57. Casali, P. G., Jost, L., Sleijfer, S., Verweij, J. & Blay, J. Y. Soft tissue sarcomas: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann. Oncol. 20 (4 Suppl.), 132–136 (2009).

    PubMed  Google Scholar 

  58. Demetri, G. D. et al. Soft tissue sarcoma. J. Natl Compr. Canc. Netw. 8, 630–674 (2010).

    Article  PubMed  Google Scholar 

  59. Gronchi, A. et al., Localized, high-risk soft tissue sarcomas (STS) of the extremities and trunk wall in adults: Three versus five cycles of full-dose anthracyclin and ifosfamide adjuvant chemotherapy: A phase III randomized trial from the Italian Sarcoma Group (ISG) and Spanish Sarcoma Group (GEIS). J. Clin. Oncol. 28 (15 Suppl.), a10003 (2010).

    Article  Google Scholar 

  60. Tierney, J. F., Mosseri, V., Stewart, L. A., Souhami, R. L. & Parmar, M. K. Adjuvant chemotherapy for soft-tissue sarcoma: review and meta-analysis of the published results of randomised clinical trials. Br. J. Cancer 72, 469–475 (1995).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Both authors researched the data for the article, provided substantial contributions to the discussion, contributed equally to the writing, review and editing of the manuscript before submission and in response to referee and editorial comments.

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Correspondence to Igor Matushansky.

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Matushansky, I., Taub, R. Adjuvant chemotherapy in 2011 for patients with soft-tissue sarcoma. Nat Rev Clin Oncol 8, 434–438 (2011). https://doi.org/10.1038/nrclinonc.2011.36

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