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Palliative Chemotherapy in Epithelioid Sarcoma. Robin L Jones, Anastasia Constantinidou, Khin Thway, Cyril Fisher, Omar Al-Muderis, Michelle Scurr, Ian R Judson Sarcoma Unit, Royal Marsden Hospital. Epithelioid sarcoma. Rare Prevalent young adults 20–40 years of age Extremities - PowerPoint PPT Presentation
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Palliative Chemotherapy in Epithelioid Sarcoma
Robin L Jones,Anastasia Constantinidou,Khin Thway, Cyril Fisher,
Omar Al-Muderis, Michelle Scurr,Ian R Judson
Sarcoma Unit, Royal Marsden Hospital
Epithelioid sarcoma
• Rare
• Prevalent young adults
• 20–40 years of age
• Extremities
• Multiple local recurrences
• Proximal-type
Methods
• Aim to document– Response– Progression-free survival
• Prospective database identify– Epithelioid sarcoma patients– Treated with chemotherapy– 1990–2009
Methods
• Histological diagnosis confirmed
• Response criteria used – RECIST– WHO
• Statistical analysis– Median and range were used for continuous variables and
proportions (%) for categorical variables– Kaplan-Meier method used to present survival data
Results
• 55 epithelioid sarcoma patients
• Epithelioid sarcoma comprise <1% of soft tissue sarcomas in database
• 20 treated with chemotherapy– 18 males– 2 females
Patient characteristics
Characteristic Number of patients
Age 33 (17-64) years
Site of primary
Upper limb
Lower limb
Head and neck
Other
8 (40%)
3 (15%)
2 (10%)
7 (35%)
Proximal variant
Yes
No
9 (45%)
11 (55%)
Primary tumour size
Median (range) 9 (2-20) cm
Treatment
• Surgery for local disease: 16 (80%)
• Surgery for metastatic disease: 9 (45%)
• Adjuvant radiotherapy: 6 (30%)
• Palliative radiotherapy: 8 (40%)
Radiotherapy post chemotherapy
• PD on chemotherapy, n=1• to pelvis
• Consolidation post chemotherapy– PR, n=2
• to chest wall
– SD, n=3• to tongue + left arm • to pelvis • to cervical spine
Results
• Adjuvant chemotherapy: 4 (20%)– One lost to follow-up
• First line chemotherapy– 2 locally advanced– 17 metastatic disease
• Metastatic sites– Pulmonary– Soft tissue– Lymph node– Hepatic– Pleura– Brain
First line chemotherapy
• One recently completed first-line therapy
• PR: 5 (28%)
• SD: 8 (44%)
• PD: 5 (28%)
First line chemotherapy
• 19 patients 19 patients
Type of treatment
No of patients
Response
PR SD PD
Recently finished
Doxorubicin 9 3 4 2
Anthracycline/ ifosfamide 8 2 3 2 1
IVAD 1 1
Trabectedin 1 1
Proximal-type
• Proximal-type– SD, n=5 (56%)– PD, n=4 (44%)
• Non-proximal type– PR, n=5 (56%)– SD, n=3 (33%)– PD, n=1 (11%)
First-line chemotherapy
• Median PFS: 7 (95%CI, 4-9) months
• Median OS: 11 (95%CI, 5-21) months
• From diagnosis
• Median OS: 33 (95%CI, 28-39) months
Progression free Survival
0
20
40
60
80
100
0 1 2Years since start of Chemotherapy
% P
rogr
essi
on f
ree
Overall Survival
0
20
40
60
80
100
0 1 2 3 4Years since start of Chemotherapy
% S
urv
ival
Second line chemotherapy
• 7 patients
Type of treatment
Number of patients
Response
PR SD PD
Ongoing
Duration of stable disease
(months)
Ifosfamide 3 1 2 11
Trabectedin 1 1
Doxorubicin 1 1
Phase I trial 2 1 1 5
Third line chemotherapy
3 patients
Type of treatment No of patients Response
PR SD PD
Ongoing
Duration of stable disease
(months)
Ifosfamide 1 1 5
Trabectedin 1 1 5
Phase I trial 1 1
Major toxicity
• Adjuvant– Ifosfamide-induced encephalopathy: 1 patient
• First-line– Neutropenic sepsis: 2 patients
• Second-line– Neutropenic sepsis: 1 patient
• Third-line – None
OS from first-line chemotherapy in all soft tissue sarcoma subtypes
Karavasilis et al, Cancer 2008: 112; 1585-1591
Conclusion
• Epithelioid sarcoma is chemosensitive
– Response rate
– Progression-free survival
Acknowledgments
• Sue Ashley
• Cerys Propert-Lewis• Alison Dunlop• Sam Hackett
• Elizabeth Barquin• Julie Dados
• Meirion Thomas• Andrew Hayes• Dirk Strauss• Frank Saran