[High-dose chemotherapy in soft tissue sarcomas of adults]

Few cytotoxic agents are active for the treatment of soft tissue sarcomas of adults: drugs active in monotherapy are doxorubicin, ifosfamide, dacarbazine and ET743. In patients with advanced stage soft tissue sarcomas (ASTS), a dose-response relationship has been established for doxorubicin and ifosfamide. Intensive combination chemotherapy regimens at conventional doses (MAID, or AI) yield higher objective response rates than monochemotherapy regimens, ranging between 25% and 44%, but failed improve survival rates as comparted to less intensive regimens. Recently, several phase I or II studies have investigated the use of high dose chemotherapy regimens as consolidation therapy in ASTS in response to conventional regimens. HDCT regimens have been reported to yield response rates ranging between 18% and 66%. Some of these patients with ASTS achieved long term complete remission, in particular in the subgroup of patients in complete remission after conventional chemotherapy in advanced phase. Phase III studies are required to confirm that survival may be improved by HDCT in subgroups of patients with ASTS.