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Pneumothorax as adverse event in patients with lung metastases of soft tissue sarcoma treated with pazopanib: a
Arie J Verschoor1, Hans Gelderblom1
1Department of Clinical Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands.
Background:
Recently, the phase III PALETTE study introduced pazopanib (Votrient®) as treatment for adult patients with locally advanced or metastatic non-liposarcoma soft tissue sarcoma after prior treatment with doxorubicin and/or ifosfamide. Pneumothorax was reported as adverse event in 8 of 246 treated patients (3.3%) in that study. This case series presents the incidence and clinic of this complication in the Leiden University Medical Centre.
Cases:
Forty-three patients were treated with pazopanib of which six patients (14.0%) developed a pneumothorax. These six patients were treated for malignant peripheral nerve sheath tumour, angiosarcoma, synovial sarcoma, fibromyxomatoid sarcoma, pleomorphic sarcoma and endometrial stromal sarcoma. All six patients had subpleural pulmonary or pleural metastases at the start of pazopanib and the pneumothorax developed during or shortly after treatment with pazopanib and was difficult to treat.
Discussion:
The incidence reported by us is higher than the incidence in the PALETTE study. Trials with pazopanib in renal cell carcinoma, urothelial carcinoma and cervix carcinoma did not report pneumothorax as an adverse event, suggesting pneumothorax as a specific adverse event in soft tissue sarcoma patients treated with pazopanib. This may be related to the fact that there is often pleural metastatic involvement and cystic degeneration due to pazopanib treatment may add to the risk.
Conclusion:
The risk of an, often difficult to treat, pneumothorax during pazopanib therapy should be discussed with the patient before initiation of treatment for a pulmonary metastasized sarcoma and physicians should be alert to the occurrence of such an event.
Insights
Pazopanib treatment for soft tissue sarcoma can cause pneumothorax, a lung complication, at a higher rate than previously reported. Patients with lung metastases face increased risk, requiring careful monitoring during pazopanib therapy.
Area of Science:
- Oncology
- Pulmonology
- Pharmacovigilance
Background:
- Pazopanib (Votrient®) is approved for advanced soft tissue sarcoma post-chemotherapy.
- The PALETTE trial reported a 3.3% pneumothorax incidence in pazopanib-treated patients.
- This case series investigates pneumothorax in pazopanib-treated patients at Leiden University Medical Centre.
Observation:
- Six out of 43 patients (14.0%) developed pneumothorax during or shortly after pazopanib treatment.
- Affected patients had various sarcoma subtypes, including malignant peripheral nerve sheath tumour and angiosarcoma.
- All patients with pneumothorax had pre-existing subpleural pulmonary or pleural metastases.
Findings:
- The observed pneumothorax incidence (14.0%) significantly exceeds the 3.3% reported in the PALETTE study.
- Pneumothorax appears to be a specific adverse event in soft tissue sarcoma patients treated with pazopanib, unlike other cancer types.
- Pre-existing pleural metastases and potential pazopanib-induced cystic degeneration may contribute to the increased risk.
Implications:
- Physicians should discuss the risk of pneumothorax with patients before initiating pazopanib for pulmonary-metastasized sarcoma.
- Increased vigilance for pneumothorax is crucial in soft tissue sarcoma patients receiving pazopanib.
- This finding highlights the need for careful patient selection and monitoring in pazopanib therapy for specific sarcoma indications.
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