High cumulative doxorubicin dose for advanced soft tissue sarcoma

Area of Science:

• Oncology
• Pharmacology
• Clinical Medicine

Background:

• Current doxorubicin dosing for soft tissue sarcoma (STS) relies on breast cancer data, which may not be optimal due to differing prognoses.
• This study addresses the need for STS-specific data regarding high-dose doxorubicin treatment.

Purpose of the Study:

• To analyze clinical data of STS patients treated with high cumulative doxorubicin doses.
• To provide evidence for optimizing doxorubicin treatment selection and clinical trial design in advanced STS.

Main Methods:

• Retrospective analysis of 170 advanced STS patients treated with doxorubicin-based chemotherapy (2016-2020).
• Patients categorized into standard-dose (≤6 cycles) and over-dose (re-challenge after 6 cycles) groups.
• Evaluated characteristics, cumulative dose, response rates (ORR, DCR), progression-free survival (PFS), and cardiotoxicity.

Main Results:

• Over-dose group (24 patients) received an average cumulative dose of 714.38 mg/m², compared to 364.04 mg/m² in the standard-dose group (146 patients).
• Objective response rate (ORR) and disease control rate (DCR) were comparable or slightly higher in the over-dose group (ORR: 16.67%, DCR: 66.67%) versus the standard-dose group (ORR: 15.07%, DCR: 58.9%).
• Cardiotoxicity incidence was low and similar in both groups (3.42% standard, 4.17% over-dose), with no drug-related deaths.

Conclusions:

• Doxorubicin continuation or re-challenge beyond the standard cumulative dose is a potentially effective strategy for advanced, chemotherapy-sensitive sarcomas.
• This approach may improve treatment outcomes without significantly increasing cardiotoxicity risk.
• Further prospective trials are recommended to validate these findings.