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Advanced soft-tissue sarcoma: a disease that is potentially curable for a subset of patients treated with
J-Y Blay1, M van Glabbeke, J Verweij
1Hospices Civils de Lyon & Ctr L.Bérard, Lyon, France. blay@lyon.fnclcc.fr
Abstract:
Adult patients with metastatic or locally advanced irresectable soft-tissue sarcoma (ASTS) are generally considered as incurable. Whether some of these patients achieve long-term survival after first-line treatment with chemotherapy is not known. Patients with ASTS still alive 5 years after initial treatment with a doxorubicin-containing regimen, i.e. long-term survivors, were analysed among the 2187 patients included in first-line chemotherapy protocols between 1976 and 1990 in seven trials of the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group (EORTC STBSG) group. 1888 patients were followed for at least 5 years. The initial clinical characteristics and the outcome of the long-term survivors were investigated. 66 of the 1888 patients were alive at 5 years and the projected 5-year survival was 8% in this series. Age or histological subtypes were similar in the long-term survivors compared with the other patients. The percentages of females (69%), of grade 1 tumours (35%), of patients with an initial performance status (PS) of 0 (63%) were significantly higher in the long-term survivors while liver metastasis (6% versus 21%) were significantly less frequent. Long-term survivors were observed in all subgroups of patients. 31, 31, 31 and 6% of the long-term survivors were in complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD), respectively, after the first-line regimen. A CR to a doxorubicin-containing regimen was the major parameter correlated to 5-year survival. In multivariate analysis using a logistic model, independent parameters correlated to 5-year survival were PS, female gender, grade I tumours, and the achievement of a CR after first-line treatment, which was retained as the most powerful predictor for 5-year survival. 10 of the 66 patients died after 5 years in this series, including 8 patients in PD or SD after first-line treatment versus 2 patients in PR or CR (P=0.01). 8% of patients with ASTS are alive 5 years after first-line chemotherapy with a doxorubicin-containing regimen. Long-term survivors are observed in all prognostic subgroups of patients, in particular those achieving a CR to first-line chemotherapy.
Insights
About 8% of adult soft-tissue sarcoma patients achieve long-term survival after first-line chemotherapy. Complete response to treatment significantly predicts 5-year survival, indicating potential for cure in some cases.
Area of Science:
- Medical Oncology
- Clinical Trials
- Sarcoma Research
Background:
- Adult soft-tissue sarcoma (ASTS) is generally considered incurable once metastatic or locally advanced.
- The potential for long-term survival after first-line chemotherapy in ASTS patients remains largely unknown.
- Previous chemotherapy protocols for ASTS have not extensively evaluated long-term outcomes.
Purpose of the Study:
- To investigate the characteristics and outcomes of adult soft-tissue sarcoma patients who achieve long-term survival (5 years) after first-line chemotherapy.
- To identify predictive factors for 5-year survival in patients with advanced or metastatic soft-tissue sarcoma.
- To determine the proportion of ASTS patients achieving long-term survival following doxorubicin-based chemotherapy.
Main Methods:
- Retrospective analysis of 2187 adult patients with ASTS from seven European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group (EORTC STBSG) trials (1976-1990).
- Focus on 1888 patients with at least 5 years of follow-up after initial doxorubicin-containing chemotherapy.
- Evaluation of clinical characteristics, treatment response (complete response, partial response, stable disease, progressive disease), and survival data.
Main Results:
- A projected 5-year survival rate of 8% was observed in the studied cohort (66 out of 1888 patients).
- Long-term survivors showed higher percentages of females (69%), grade 1 tumors (35%), and initial performance status of 0 (63%), with less frequent liver metastasis.
- Complete response (CR) to first-line chemotherapy was the strongest predictor of 5-year survival, followed by performance status, female gender, and grade I tumors.
Conclusions:
- Approximately 8% of adult soft-tissue sarcoma patients treated with first-line doxorubicin-containing chemotherapy can achieve 5-year survival.
- Long-term survival is possible across various prognostic subgroups, particularly for patients achieving a complete response.
- Complete response to initial chemotherapy is a crucial factor for predicting long-term survival in advanced soft-tissue sarcoma.