palliative chemotherapy in epithelioid sarcoma
DESCRIPTION
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 PresentationTRANSCRIPT
![Page 1: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/1.jpg)
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
![Page 2: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/2.jpg)
Epithelioid sarcoma
• Rare
• Prevalent young adults
• 20–40 years of age
• Extremities
• Multiple local recurrences
• Proximal-type
![Page 3: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/3.jpg)
Methods
• Aim to document– Response– Progression-free survival
• Prospective database identify– Epithelioid sarcoma patients– Treated with chemotherapy– 1990–2009
![Page 4: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/4.jpg)
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
![Page 5: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/5.jpg)
Results
• 55 epithelioid sarcoma patients
• Epithelioid sarcoma comprise <1% of soft tissue sarcomas in database
• 20 treated with chemotherapy– 18 males– 2 females
![Page 6: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/6.jpg)
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
![Page 7: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/7.jpg)
Treatment
• Surgery for local disease: 16 (80%)
• Surgery for metastatic disease: 9 (45%)
• Adjuvant radiotherapy: 6 (30%)
• Palliative radiotherapy: 8 (40%)
![Page 8: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/8.jpg)
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
![Page 9: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/9.jpg)
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
![Page 10: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/10.jpg)
First line chemotherapy
• One recently completed first-line therapy
• PR: 5 (28%)
• SD: 8 (44%)
• PD: 5 (28%)
![Page 11: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/11.jpg)
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
![Page 12: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/12.jpg)
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%)
![Page 13: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/13.jpg)
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
![Page 14: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/14.jpg)
Progression free Survival
0
20
40
60
80
100
0 1 2Years since start of Chemotherapy
% P
rogr
essi
on f
ree
![Page 15: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/15.jpg)
Overall Survival
0
20
40
60
80
100
0 1 2 3 4Years since start of Chemotherapy
% S
urv
ival
![Page 16: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/16.jpg)
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
![Page 17: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/17.jpg)
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
![Page 18: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/18.jpg)
Major toxicity
• Adjuvant– Ifosfamide-induced encephalopathy: 1 patient
• First-line– Neutropenic sepsis: 2 patients
• Second-line– Neutropenic sepsis: 1 patient
• Third-line – None
![Page 19: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/19.jpg)
OS from first-line chemotherapy in all soft tissue sarcoma subtypes
Karavasilis et al, Cancer 2008: 112; 1585-1591
![Page 20: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/20.jpg)
Conclusion
• Epithelioid sarcoma is chemosensitive
– Response rate
– Progression-free survival
![Page 21: Palliative Chemotherapy in Epithelioid Sarcoma](https://reader033.vdocuments.site/reader033/viewer/2022061605/568146af550346895db3cb15/html5/thumbnails/21.jpg)
Acknowledgments
• Sue Ashley
• Cerys Propert-Lewis• Alison Dunlop• Sam Hackett
• Elizabeth Barquin• Julie Dados
• Meirion Thomas• Andrew Hayes• Dirk Strauss• Frank Saran