Gina Z. D’Amato, MD, discusses optimizing treatment for patients with desmoid tumors.
Gina Z. D’Amato, MD, associate professor, assistant director of clinical research, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses optimizing treatment for patients with desmoid tumors.
All patients with desmoid tumors should be observed initially until they develop indications for treatment, D’Amato says. Indications for treatment include tumor growth that could impede or threaten quality of life or cause deformity, dysfunction, or pain. Additionally, growing tumors may be observed, unless they are in areas such as the intra-abdominal wall where other organs can be affected, the head or neck where major blood vessels are involved, or the appendages where they may hinder activity, D’Amato explains.
Historically surgery was the mainstay of treatment for patients with desmoid tumors; however, the field is significantly limiting surgery now because these tumors may regress or disappear without therapeutic intervention, D’Amato says. Now, based on recommendations from the Desmoid Tumor Working Group guidelines, surgery is indicated only in cases where resection will not cause deformity, such as the intra-abdominal wall.
If treatment is indicated, systemic therapy offers patients a less morbid alternative to surgery, D’Amato says. Systemic treatment selection is based on factors, such as tumor location and patient symptoms. Typically, sorafenib (Nexavar) is the recommended first-line therapy and is generally well tolerated. Systemic chemotherapy can also be considered, although it is associated with substantial toxicities, D’Amato concludes.
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