Salvage chemotherapy for advanced sarcoma patients: a single-institution experience survey

There is no standard salvage chemotherapy for patients with recurrent sarcoma following a first-line chemotherapy. A few therapeutic options are available and of limited efficacy. The objective of this study was to determine the activity and toxicity of salvage therapies in advanced sarcoma patients in our experience. A retrospective analysis of 41 case records of patients with recurrent sarcoma treated at our division between May 1995 and October 2000 was conducted. Several different therapy regimens were employed: dacarbazine (DTIC) in 16 patients; carboplatin (CBDCA) plus gemcitabine (GEM) in 9 patients; ifosfamide (IFO) in 10 patients; other regimens in 6 patients. A total of 153 cycles of chemotherapy were delivered (median, 3 cycles). Among 38 evaluable patients, seven partial responses were obtained (RR 18.4%). Treatment-related responses were: 2/15 in DTIC group; 1/8 in CBDCA/GEM group; 3/9 in IFO group; 1/6 in other regimens. Stable disease was obtained in 10 patients. Median time to treatment failure and median survival time were 5 months and 4.5 months, respectively. The main treatment-related toxicities were hematologic and gastrointestinal. Most of salvage chemotherapies for recurrent sarcoma patients have an unacceptably high treatment failure rate and do not appear to offer any quality of life advantages. Future clinical trials with high dose ifosfamide seem appropriate even if the use of investigational new drugs and novel strategies in these patients should be considered.