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Future Directions in Soft Tissue Sarcoma

Panelists:Robin L. Jones, MD, MRCP, Royal Marsden Hospital; Shreyaskumar R. Patel, MD, University of Texas MD Anderson Cancer Center; R. Lor Randall, MD, FACS, Huntsman Cancer Institute; Jonathan C. Trent, MD, Sylvester Comprehensive Cancer Center; Brian A. Van Tine, MD, PhD, Siteman Cancer Center; Andrew J. Wagner, MD, PhD, Dana-Farber Cancer Institute
Published: Monday, Feb 01, 2016


Transcript:

Brian A. Van Tine, MD, PhD:
I believe this has been a really great discussion. We’ve reviewed and discussed a lot of information today. We’ve talked a lot about the management and treatment of soft tissue sarcomas. Before we conclude, I’d like to ask each of our panelists to share some final thoughts. I’d like to start with you, Dr. Patel.

Shreyaskumar R. Patel, MD: I think the final thoughts would be to emphasize the fact that this is a complex and a heterogeneous disease. I think it’s important that a multidisciplinary discussion be held. For our community oncology folks, please feel free to pick up the phone and call your local referral center where they may have experience and expertise.

There are clearly a lot of moving parts in terms of diagnosis and treatment now. I think to provide the best care to the patient, early involvement of experienced multidisciplinary teams can be very helpful for better patient care in the long run.

Brian A. Van Tine, MD, PhD: Dr. Wagner?

Andrew J. Wagner, MD, PhD: I certainly agree with those comments. I also would point out that we’ve seen several examples of randomized phase III studies being conducted in sarcoma. So, it used to be thought that these are rare diseases, you can’t do these types of studies. And I think it reflects the sarcoma community, which extends to community oncologists who refer patients in for clinical trials, but also the national and international groups that participate quite collaboratively in conducting these studies and relatively rapidly getting to answers about whether or not the drugs are effective.

I think that that’s how we’re going to keep moving forward with this, is to continue to do these studies. I also think that these studies show, especially the trabectedin/eribulin studies, show very nicely that we can parse out some subtypes of sarcoma. I’d like to see that go even further because lumping leiomyosarcoma and liposarcoma in a study together is still putting breast cancer and colon cancer together in a study.

So, I think as we can enroll more patients across the world in these studies, we can look at smaller subgroups and try to get more definitive answers according to the biology of the tumors.

Brian A. Van Tine, MD, PhD: Dr. Jones?

Robin L. Jones, MD, MRCP: Yes. I’d agree with those 2 points. I’d also like to emphasize that the number of randomized trials that have been done over the last few years in sarcoma with the GIST trials that we’ve not really discussed, is phenomenal. And as you say, Andy, the fact that those trials have recruited very, very quickly, I think the important thing to move things forward, we need to emphasize the importance of clinical trials.

We need to emphasize the importance of ongoing research, both clinical and laboratory-based research, because that’s really the only way we’re going to make things better for our patients.

Brian A. Van Tine, MD, PhD: Dr. Randall?

R. Lor Randall, MD, FACS: Agreeing with everything that’s been said, and it is a time of cautious optimism. A lot of biotargeting going on, a lot of exciting tools being put in our armamentarium. Having said that, as we potentially move the curves to the right, I think we also need to remember it still will come at a cost to the patient and their families’ lives. They’re going to have a psychological burden, psychological scar, physical scar. This is a devastating, functional type of cancer.

We need to keep the message out there that there is a comprehensive team that will chaperone and shepherd these people through the process, hopefully curing them or keeping their tumor at bay, but that we will also be there for them down the road because they will have life-altering events no matter what happens.

Brian A. Van Tine, MD, PhD: Any final thoughts, Jonathan?

Jonathan C. Trent, MD: Of course, I agree with all of the previous speakers, and I would also like to emphasize that multidisciplinary care is critical in terms of diagnosis, establishing treatment recommendations, managing treatment complications or toxicities, and then managing patients long-term in terms of late toxicities and managing their follow-up imaging such as MRI, CT scans, blood tests over time, best done through a multidisciplinary center with input from everybody on the team and, particularly, development of clinical trials that are multidisciplinary.

I don’t think we do enough of those in the sarcoma world. And incorporating as many biomarkers and molecular pieces of information that we can—since we’re losing valuable information in determining who’s going to benefit from a therapy and who is perhaps going to have toxicity. and who is not—I think that’s really the direction forward.

Brian A. Van Tine, MD, PhD: I think my final thought, which is just—I love this field. What I’ve seen since I entered this field, and it’s almost been a decade now, is that it’s gone from a very small field with small meetings to larger meetings. Even this year, for the first time, we have our first AACR Sarcoma Meeting which really shows that between our industry partners for clinical trial, the drug development, the fact that we come with rare tumor indications and 80 tumors, 80 different histologies, if you have a drug, we probably have a cancer you can study. Then on top of that, just the most amazing patients that exist. I mean this is just a really neat field to be part of. I’d like to thank everybody for participating. And on behalf of our panel, we’d like to thank you for joining us and we hope you found this Peer Exchange to be useful and informative.
                                                                                                                                                                                                                                                                                                                
Transcript Edited for Clarity
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Transcript:

Brian A. Van Tine, MD, PhD:
I believe this has been a really great discussion. We’ve reviewed and discussed a lot of information today. We’ve talked a lot about the management and treatment of soft tissue sarcomas. Before we conclude, I’d like to ask each of our panelists to share some final thoughts. I’d like to start with you, Dr. Patel.

Shreyaskumar R. Patel, MD: I think the final thoughts would be to emphasize the fact that this is a complex and a heterogeneous disease. I think it’s important that a multidisciplinary discussion be held. For our community oncology folks, please feel free to pick up the phone and call your local referral center where they may have experience and expertise.

There are clearly a lot of moving parts in terms of diagnosis and treatment now. I think to provide the best care to the patient, early involvement of experienced multidisciplinary teams can be very helpful for better patient care in the long run.

Brian A. Van Tine, MD, PhD: Dr. Wagner?

Andrew J. Wagner, MD, PhD: I certainly agree with those comments. I also would point out that we’ve seen several examples of randomized phase III studies being conducted in sarcoma. So, it used to be thought that these are rare diseases, you can’t do these types of studies. And I think it reflects the sarcoma community, which extends to community oncologists who refer patients in for clinical trials, but also the national and international groups that participate quite collaboratively in conducting these studies and relatively rapidly getting to answers about whether or not the drugs are effective.

I think that that’s how we’re going to keep moving forward with this, is to continue to do these studies. I also think that these studies show, especially the trabectedin/eribulin studies, show very nicely that we can parse out some subtypes of sarcoma. I’d like to see that go even further because lumping leiomyosarcoma and liposarcoma in a study together is still putting breast cancer and colon cancer together in a study.

So, I think as we can enroll more patients across the world in these studies, we can look at smaller subgroups and try to get more definitive answers according to the biology of the tumors.

Brian A. Van Tine, MD, PhD: Dr. Jones?

Robin L. Jones, MD, MRCP: Yes. I’d agree with those 2 points. I’d also like to emphasize that the number of randomized trials that have been done over the last few years in sarcoma with the GIST trials that we’ve not really discussed, is phenomenal. And as you say, Andy, the fact that those trials have recruited very, very quickly, I think the important thing to move things forward, we need to emphasize the importance of clinical trials.

We need to emphasize the importance of ongoing research, both clinical and laboratory-based research, because that’s really the only way we’re going to make things better for our patients.

Brian A. Van Tine, MD, PhD: Dr. Randall?

R. Lor Randall, MD, FACS: Agreeing with everything that’s been said, and it is a time of cautious optimism. A lot of biotargeting going on, a lot of exciting tools being put in our armamentarium. Having said that, as we potentially move the curves to the right, I think we also need to remember it still will come at a cost to the patient and their families’ lives. They’re going to have a psychological burden, psychological scar, physical scar. This is a devastating, functional type of cancer.

We need to keep the message out there that there is a comprehensive team that will chaperone and shepherd these people through the process, hopefully curing them or keeping their tumor at bay, but that we will also be there for them down the road because they will have life-altering events no matter what happens.

Brian A. Van Tine, MD, PhD: Any final thoughts, Jonathan?

Jonathan C. Trent, MD: Of course, I agree with all of the previous speakers, and I would also like to emphasize that multidisciplinary care is critical in terms of diagnosis, establishing treatment recommendations, managing treatment complications or toxicities, and then managing patients long-term in terms of late toxicities and managing their follow-up imaging such as MRI, CT scans, blood tests over time, best done through a multidisciplinary center with input from everybody on the team and, particularly, development of clinical trials that are multidisciplinary.

I don’t think we do enough of those in the sarcoma world. And incorporating as many biomarkers and molecular pieces of information that we can—since we’re losing valuable information in determining who’s going to benefit from a therapy and who is perhaps going to have toxicity. and who is not—I think that’s really the direction forward.

Brian A. Van Tine, MD, PhD: I think my final thought, which is just—I love this field. What I’ve seen since I entered this field, and it’s almost been a decade now, is that it’s gone from a very small field with small meetings to larger meetings. Even this year, for the first time, we have our first AACR Sarcoma Meeting which really shows that between our industry partners for clinical trial, the drug development, the fact that we come with rare tumor indications and 80 tumors, 80 different histologies, if you have a drug, we probably have a cancer you can study. Then on top of that, just the most amazing patients that exist. I mean this is just a really neat field to be part of. I’d like to thank everybody for participating. And on behalf of our panel, we’d like to thank you for joining us and we hope you found this Peer Exchange to be useful and informative.
                                                                                                                                                                                                                                                                                                                
Transcript Edited for Clarity
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