Twenty-five years without progress: The enduring challenge of soft tissue sarcomas

Over the past decade, remarkable improvements have been seen in oncology. The survival rate for breast cancer has more than doubled since 1975. Even diseases previously known for having poor prognoses, such as lung cancer, saw an improvement in survival over this period. To that end, the aim of this commentary is to evaluate how patients with soft tissue sarcoma (STS) fared during this period. By analyzing data from 21,948 patients with STS (excluding gastrointestinal stromal tumor [GIST]) from the Surveillance, Epidemiology, and End Results 9 registries, this study determined that the median survival has remained stagnant from 1999 to 2019 (66-68 months); even when stratified by localized or distant disease, no significant difference was seen. However, when looking specifically at GIST (n = 3716), there was a steady improvement in survival during the same period, with the median survival increasing from 105 months in 1999-2004 to 122 months in 2005-2011. These survival improvements were seen in both localized and distant settings. Multiple factors can be attributed to the stagnation of STS in comparison with other cancers, including the lack of understanding of its biological mechanisms, difficulties in conducting research in rare diseases, and lack of commercial interest in positioning drugs in this disease. The contrasting progress in GIST highlights that this reality can be changed; by understanding the biological drivers, actionable targets can be found and novel drugs can be positioned to improve survival.