Histology-tailored neoadjuvant chemotherapy not associated with better overall survival in high-risk soft-tissue sarcoma

No disease-free or overall survival benefit was found in patients with high-risk soft-tissue sarcoma treated with histology-tailored neoadjuvant chemotherapy versus standard anthracycline/ifosfamide neoadjuvant chemotherapy, according to a study published in the Journal of Clinical Oncology.

In this randomized, open-label, phase 3 trial, 287 patients with localized high-risk soft-tissue sarcoma of an extremity or trunk wall, including high-grade myxoid liposarcoma (HG-MLPS), leiomyosarcoma (LMS), synovial sarcoma (SS), malignant peripheral nerve sheath tumor (MPNST), and undifferentiated pleomorphic sarcoma (UPS), were randomly assigned to receive 3 cycles of anthracycline/ifosfamide neoadjuvant chemotherapy or histology-tailored neoadjuvant chemotherapy. Histology-tailored neoadjuvant chemotherapy regimens included trabectedin in HG-MLPS, gemcitabine plus dacarbazine in LMS, high-dose prolonged-infusion ifosfamide in SS, etoposide plus ifosfamide in MPNST, and gemcitabine plus docetaxel in UPS.

After a median follow-up of 52 months, the projected disease-free survival and overall survival probabilities in the anthracycline/ifosfamide arm were 0.55 and 0.76 at 60 months; in the histology-tailored arm it was 0.47 and 0.66, respectively.

The authors concluded, “that [anthracycline/ifosfamide] should remain the regimen to choose whenever neoadjuvant chemotherapy is used in patients with high-risk soft-tissue sarcoma.”

Reference
Neoadjuvant chemotherapy in high-risk soft tissue sarcomas: final results of a randomized trial from Italian (ISG), Spanish (GEIS), French (FSG), and Polish (PSG) Sarcoma Groups. J Clin Oncol. 2020;38(19):2178-2186. DOI: 10.1200/JCO.19.03289