ISG-STS 1001: histotype-tailored neoadjuvant chemotherapy versus standard chemotherapy in high-risk soft tissue sarcoma
Trying to match neoadjuvant chemotherapy to sarcoma subtype backfired: standard epirubicin-ifosfamide gave better disease-free and overall survival than the tailored regimens, and in doing so provided evidence that neoadjuvant anthracycline-ifosfamide itself helps high-risk patients.
Overview
Phase 3 trial of 287 patients with high-risk localised soft tissue sarcoma of the limbs or trunk wall in five histological subtypes randomised to three cycles of neoadjuvant epirubicin-ifosfamide or a histotype-tailored regimen (gemcitabine-docetaxel, trabectedin, high-dose ifosfamide, etoposide-ifosfamide or gemcitabine-dacarbazine).
The trial stopped early for futility: 46-month disease-free survival was 62 percent with standard chemotherapy against 38 percent with tailored regimens, and overall survival 89 versus 64 percent, with the difference driven by undifferentiated pleomorphic sarcoma and other subtypes.
- 46-month disease-free survival 62 percent (standard) vs 38 percent (tailored).
- Overall survival 89 percent vs 64 percent.
Three cycles of neoadjuvant anthracycline-ifosfamide is a reasonable standard for fit patients with high-risk limb or trunk sarcoma, particularly undifferentiated pleomorphic sarcoma.
- Absence of a surgery-alone arm means the benefit of chemotherapy is inferred rather than proven.
- Tailored regimens performed worse partly because some had little single-agent activity.
Similar pages
not linked directly; found by shared links- TermFNCLCC grade (soft-tissue sarcoma)
Shares ISG-STS 1001, Undifferentiated pleomorphic sarcoma (UPS), Soft tissue sarcoma of the extremity (localised and advanced).
- Key paperEORTC 62012: doxorubicin alone versus intensified doxorubicin plus ifosfamide for first-line treatment of advanced soft tissue sarcoma
Shares Synovial sarcoma, Undifferentiated pleomorphic sarcoma (UPS), Soft tissue sarcoma of the extremity (localised and advanced), The Lancet Oncology.
- TermHistotype-tailored therapy
Shares ISG-STS 1001, Soft tissue sarcoma of the extremity (localised and advanced).
- Key paperSARC028: pembrolizumab in advanced soft tissue and bone sarcoma
Shares Undifferentiated pleomorphic sarcoma (UPS), The Lancet Oncology.
- TrialEORTC 62012
Shares Undifferentiated pleomorphic sarcoma (UPS), Soft tissue sarcoma of the extremity (localised and advanced).
- Key paperLMS-04: doxorubicin plus trabectedin followed by trabectedin maintenance versus doxorubicin alone in metastatic leiomyosarcoma
Shares Soft tissue sarcoma of the extremity (localised and advanced), The Lancet Oncology.
- TreatmentTrabectedin
Shares Synovial sarcoma, Undifferentiated pleomorphic sarcoma (UPS), Soft tissue sarcoma of the extremity (localised and advanced).
- Key paperSoft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS clinical practice guideline
Shares Undifferentiated pleomorphic sarcoma (UPS), Soft tissue sarcoma of the extremity (localised and advanced).