Dr Somaiah on the Role of Chemotherapy in Sarcomas

“We still use chemotherapy to begin with [in treating patients with sarcomas], but there are a lot of targeted therapy options and clinical trials that we think of. For some of the disease subtypes, targeted therapies have replaced chemotherapy, which is quite exciting.”

Neeta Somaiah, MD, professor, department chair, Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the role of chemotherapy in the management of sarcomas.

In the realm of sarcomas, chemotherapy is still considered the mainstay of treatment, especially in patients with metastatic or locally advanced disease, Somaiah begins. In the past 5 years, the list of chemotherapy options and regimens has been smaller, she explains. However, she notes that there has been a growing list of immunotherapies and targeted therapies, which continues to expand.

Now, subtypes of sarcomas and more biomarkers are being better established, Somaiah says. Having these identified helps determine optimal treatment options, particularly for rarer subtypes of sarcoma, she adds.

Of note, in August 2024, the FDA granted accelerated approval to afamitresgene autoleucel (afami-cel; Tecelra) for the treatment of patients with unresectable or metastatic synovial sarcoma. Subsequently, in September 2024, the FDA approved atezolizumab and hyaluronidase-tqjs (Tecentriq Hybreza) for subcutaneous injection for the use of all of the existing adult indications as the intravenous formulation of atezolizumab (Tecentriq), which included alveolar soft part sarcoma, among other solid tumors. Atezolizumab was previously approved by the FDA in December 2022 for the treatment of adult and pediatric patients at least 2 years of age with alveolar soft part sarcoma.

Therefore, the shift from chemotherapy-only regimens to immunotherapies has been seen in select sarcoma subtypes, Somaiah notes. Chemotherapy is typically where treatment starts; nonetheless, more clinical trials and approved immunotherapies are starting to replace the use of chemotherapy, which is exciting, she concludes.