Brian A. Van Tine, MD, PhD
With scores of subtypes and a paucity of molecular markers, soft tissue sarcoma (STS) remains a complex and challenging tumor type to treat yet significant strides being made in the field are likely to alter the therapeutic paradigm, according to experts who participated in a recent OncLive Peer Exchange®
The program, entitled “Multidisciplinary Treatment of Advanced Soft Tissue Sarcomas,” delved into promising new agents and therapeutic strategies that are helping to extend survival and improve quality of life for patients with STS. Led by moderator Brian A. Van Tine, MD, PhD, the panel also discussed the complexities associated with diagnosis and treatment of STS, and the importance of individualizing care.
“This field, for the first time in a very long time…has an influx of potential new drugs that are going to very quickly start changing the landscape of how the non-surgeons approach the tumors,” stated Van Tine, director, Sarcoma Program Barnes and Jewish Hospital Washington University in St. Louis.
Indeed, the armamentarium expanded in October with the FDA’s approval of trabectedin (Yondelis) for the treatment of patients with unresectable or metastatic liposarcoma or leiomyosarcoma who have previously received anthracycline- based chemotherapy.
Importance of Multidisciplinary Care
With fewer than 12,000 annual diagnoses in the United States and 50 or more subtypes, STSs are both rare and heterogeneous. Multidisciplinary care, which may include a pathologist, radiologist, surgeon, oncologist, a gastroenterologist, nurse, geneticist, and social worker, is of particular importance in this complex group of diseases, the Peer Exchange panelists said.
Some of the most common STS subtypes fall under the categories of leiomyosarcoma, liposarcoma/ adipocytic sarcoma, and nondescript spindle cell sarcoma.
Robin L. Jones, MD, MRCP
randa Obtaining a clear and accurate histological diagnosis prior to starting treatment is essential, since each subtype can differ in underlying biology, clinical behavior, and response to treatment, according to Robin L. Jones, MD, MRCP.
The system in the United Kingdom, where Jones practices, differs from the system in the United States, in that all sarcoma patients in the United Kingdom are referred directly to a sarcoma center following an STS diagnosis, explained Jones, Medical Oncologist Royal Marsden Hospital Institute of Cancer Research London, England. “The complexity both in terms of heterogeneity, rarity, and the wide variety of anatomic primary sites just make it very, very challenging [to treat],” Jones said.
According to the French grading system, tumors are graded as low, intermediate, and high, based on tumor differentiation, tumor necrosis, and mitotic count. This assessment has important implications in terms of prognosis, Jones stated.
R. Lor Randall, MD
Also, prior to any intervention, it is important to conduct chest imaging, as the chest is the most common site for STS tumors to metastasize,new said R. Lor Randall, MD, FACS. Radiological images and clinical features, together with a report from a pathologist experienced with STS, are needed to make a definitive diagnosis prior to beginning treatment.
“As a surgeon I need to understand the biology, the medical oncology, the radiation therapeutics available, the leading-edge thought,” noted Randall, director, Sarcoma Services medical director, Surgical Services, Huntsman Cancer Institute. “The physicians that are involved more in the systemic management also need to understand the local control issues, because we know that surgery and radiation therapy are backbones…for curing and managing sarcomas.”