Chemotherapy for soft-tissue sarcomas

Single-agent and combination chemotherapy have greater than 20% single-agent activity: doxorubicin and ifosfamide. Certain other anthracycline analogues possess similar activity. It remains a question whether combination therapy is any better than single-agent doxorubicin. Randomized trials have demonstrated enhanced response rates and increased toxicity for the combinations, but survival, with limited follow-up data, is not improved. The role of adjuvant chemotherapy also is not yet established. Two of 12 trials demonstrate survival benefits; however, most show a delay in relapse with about a 10% risk of irreversible toxicity. New agents, targets, and methods to circumvent resistance mechanisms developed in the laboratory are necessary to advance the field.