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Conclusions on Management of Advanced STS

Panelists: William D. Tap, MD, Memorial Sloan Kettering Cancer Center; Kristen Ganjoo, MD, Stanford University Medical Center; Richard Riedel, MD, Duke Cancer Institute; Jonathan Trent, MD, PhD, Sylvester Comprehensive Cancer Center; Victor Villalobos, MD, PhD, University of Colorado
Published: Tuesday, Sep 04, 2018



Transcript: 

William D. Tap, MD: This has been a really informative discussion. But before we end, I’d like to get your final thoughts, maybe 30 seconds or a minute, and we’ll start with Dr. Ganjoo.

Kristen N. Ganjoo, MD: Just to recap, multidisciplinary discussion of patients with sarcoma is very important. As John mentioned, there are so many different variety of sarcomas. They’re all treated differently. Sarcomas are 1% of all cancers, and it’s impossible for the community physicians, physicians who are not specialized in sarcoma, to know exactly how to treat these patients. Sending patients to a tertiary care center is extremely important. Pathology review is important. Getting input from the surgeons, the chemotherapy physicians, and the radiation physicians is extremely essential for the patient’s treatment to go well and for patients to have a good chance. It’s always important. That first chance is always important.

William D. Tap, MD: Yes, and that’s the perfect conclusion to sarcoma. Dr. Trent?

Jonathan C. Trent, MD, PhD: I’d just like to reiterate the multidisciplinary component. Really, the foundation of everything we do is based on pathology. Whenever possible, a sarcoma specimen should be reviewed by a sarcoma pathologist. We know that 15% to 20% of the time, the diagnosis is changed when reviewed by a sarcoma specialist. That’s really the foundation all of our therapies are built on. We have so many new exciting therapies like pazopanib, olaratumab, eribulin, and trabectedin. These are new, and many of them are histology-specific and benefit specific histologies. We have to work closely with our pathologists, and we have to use their expertise so that we can leverage all of these exciting new therapies for our patients and look forward to some potentially exciting combinations in the future.

William D. Tap, MD: I agree. Dr. Villalobos?

Victor M. Villalobos, MD, PhD: These are rare cancers. Because they’re so rare and so heterogeneous, we don’t have data like we do in breast cancer. That’s why it’s so important that there’s a lot of nuance involved in how we treat these patients. Guidelines can be very effective, but they’re not that effective in sarcoma because of the lack of data, frankly. That’s why it’s so important to have colleagues who have experience in these things and to lean on us to try and come up with good plans. There are a lot of new drugs. It’s a fascinating field to be in because of the fact that these have very, very different biology—such a widespread amount—whether it be mutated versus modifications in their genome, copy numbers, or translocation-based tumors. It encompasses them all, so we’re making a lot progress here.

William D. Tap, MD: And Dr. Riedel, do you want to have the last comment?

Richard F. Riedel, MD: What I would say is I think it’s an extremely exciting time to be in the field. The treatment for sarcoma has become increasingly nuanced. We went 40 years with no FDA approval, and we’ve had 4 approvals within the last 5 years. I think it’s incredibly exciting. The idea that there is no effective treatment for sarcoma, or the idea of therapeutic nihilism, really needs to go away because we are clearly making advances for our patients.

William D. Tap, MD: I agree. Thank you so much for this really wonderful discussion. On behalf of our panel, we’d like to thank you for joining us and we hope you found the Peer Exchange discussion to be useful and informative. Thank you.

Transcript Edited for Clarity 

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Transcript: 

William D. Tap, MD: This has been a really informative discussion. But before we end, I’d like to get your final thoughts, maybe 30 seconds or a minute, and we’ll start with Dr. Ganjoo.

Kristen N. Ganjoo, MD: Just to recap, multidisciplinary discussion of patients with sarcoma is very important. As John mentioned, there are so many different variety of sarcomas. They’re all treated differently. Sarcomas are 1% of all cancers, and it’s impossible for the community physicians, physicians who are not specialized in sarcoma, to know exactly how to treat these patients. Sending patients to a tertiary care center is extremely important. Pathology review is important. Getting input from the surgeons, the chemotherapy physicians, and the radiation physicians is extremely essential for the patient’s treatment to go well and for patients to have a good chance. It’s always important. That first chance is always important.

William D. Tap, MD: Yes, and that’s the perfect conclusion to sarcoma. Dr. Trent?

Jonathan C. Trent, MD, PhD: I’d just like to reiterate the multidisciplinary component. Really, the foundation of everything we do is based on pathology. Whenever possible, a sarcoma specimen should be reviewed by a sarcoma pathologist. We know that 15% to 20% of the time, the diagnosis is changed when reviewed by a sarcoma specialist. That’s really the foundation all of our therapies are built on. We have so many new exciting therapies like pazopanib, olaratumab, eribulin, and trabectedin. These are new, and many of them are histology-specific and benefit specific histologies. We have to work closely with our pathologists, and we have to use their expertise so that we can leverage all of these exciting new therapies for our patients and look forward to some potentially exciting combinations in the future.

William D. Tap, MD: I agree. Dr. Villalobos?

Victor M. Villalobos, MD, PhD: These are rare cancers. Because they’re so rare and so heterogeneous, we don’t have data like we do in breast cancer. That’s why it’s so important that there’s a lot of nuance involved in how we treat these patients. Guidelines can be very effective, but they’re not that effective in sarcoma because of the lack of data, frankly. That’s why it’s so important to have colleagues who have experience in these things and to lean on us to try and come up with good plans. There are a lot of new drugs. It’s a fascinating field to be in because of the fact that these have very, very different biology—such a widespread amount—whether it be mutated versus modifications in their genome, copy numbers, or translocation-based tumors. It encompasses them all, so we’re making a lot progress here.

William D. Tap, MD: And Dr. Riedel, do you want to have the last comment?

Richard F. Riedel, MD: What I would say is I think it’s an extremely exciting time to be in the field. The treatment for sarcoma has become increasingly nuanced. We went 40 years with no FDA approval, and we’ve had 4 approvals within the last 5 years. I think it’s incredibly exciting. The idea that there is no effective treatment for sarcoma, or the idea of therapeutic nihilism, really needs to go away because we are clearly making advances for our patients.

William D. Tap, MD: I agree. Thank you so much for this really wonderful discussion. On behalf of our panel, we’d like to thank you for joining us and we hope you found the Peer Exchange discussion to be useful and informative. Thank you.

Transcript Edited for Clarity 
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