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Clinical impact of trabectedin (ecteinascidin-743) in advanced/metastatic soft tissue sarcoma
Patrick Schöffski1, Herlinde Dumez, Pascal Wolter
1Catholic University Leuven, University Hospital Gasthuisberg, Department of General Medical Oncology, Leuven Cancer Institute, Herestraat 49, 3000 Leuven, Belgium. patrick.schoffski@uz.kuleuven.be
Background:
Patients with advanced or metastatic non-gastrointestinal stromal tumour soft tissue sarcoma (STS) whose disease progresses during or after chemotherapy with doxorubicin or ifosfamide have few options and very limited life expectancy. In this setting, the DNA and transcription interacting agent trabectedin (ecteinascidin-743), isolated originally from the tunicate Ecteinascidia turbinata, has encouraging activity and is now approved in the European Union.
Objective:
To review evidence for the efficacy of trabectedin in STSs.
Methods:
This review includes material known to the authors through preclinical and clinical work with trabectedin, and information from relevant papers and abstracts.
Results:
Pooled analysis of Phase II studies suggests that around 50% of STS patients, failing conventional chemotherapy, experienced long lasting tumour control (either objective response or stabilization of disease) when treated with trabectedin. Twenty-nine per cent of patients were alive at 2 years, and median overall survival was 10.3 months. Leiomyosarcomas and liposarcomas appear particularly sensitive to the drug. In myxoid and round-cell liposarcomas trabectedin seems exceptionally active. A link between specific translocations underlying this disease and the drug's mechanism of action is being explored. Trabectedin is also active in synovial, ewing sarcoma and other translocation-related STSs. Trabectedin is not cardio- or neurotoxic. The neutropenia and hepatic toxicity that occur are non-cumulative, reversible, and lessened by steroid premedication. The lack of cumulative toxicities could make trabectedin appropriate for prolonged treatment.
Conclusion:
The potential of trabectedin should be further explored in STSs in general and in specific subtypes, both in combination with other cytotoxic agents and with modulators of intracellular signalling.
Insights
Trabectedin shows promising efficacy in soft tissue sarcoma (STS) patients resistant to conventional chemotherapy, offering long-lasting tumor control and improved survival. This agent demonstrates particular activity in specific STS subtypes with manageable toxicity, warranting further investigation.
Area of Science:
- Oncology
- Pharmacology
- Molecular Biology
Background:
- Advanced or metastatic soft tissue sarcoma (STS) patients progressing on doxorubicin or ifosfamide have limited treatment options.
- Trabectedin (ecteinascidin-743), a DNA and transcription-interacting agent, has shown encouraging activity in this patient population.
- Trabectedin is approved in the European Union for STS treatment.
Purpose of the Study:
- To review the evidence for trabectedin's efficacy in soft tissue sarcomas (STSs).
Main Methods:
- Review of preclinical and clinical data on trabectedin.
- Inclusion of relevant published papers and abstracts.
Main Results:
- Pooled Phase II studies indicate approximately 50% of STS patients achieve long-term tumor control with trabectedin.
- 29% of patients survived at 2 years, with a median overall survival of 10.3 months.
- Leiomyosarcomas, liposarcomas (especially myxoid and round-cell subtypes), synovial sarcoma, and Ewing sarcoma show particular sensitivity; mechanism exploration is ongoing. Trabectedin exhibits manageable, non-cumulative toxicities (neutropenia, hepatic toxicity) reversible with steroid premedication and lacks cardiotoxicity and neurotoxicity.
Conclusions:
- Trabectedin demonstrates significant potential in treating STSs, particularly specific subtypes.
- Further research should explore trabectedin in combination therapies for STSs, including with cytotoxic agents and intracellular signaling modulators.
