Soft Tissue Sarcoma Flashcards
Treatment -Pazopanib Adverse effects -6
VIDEO**
Fatigue,
diarrhea,
nausea,
weight-loss,
hypertension.
Black boxed warning for hepatotoxicity.
Treatment -Pazopanib in advanced STS -6
FDA APPROVED
1ST to show efficacy in non-GIST STS
Advanced STS who have received prior chemotherapy.
TKI
Best in leiomyosarcoma
PFS 4.6 months versus 1.6 months
No significant increase in OS
Not recommended for liposarcoma (ADIPOCYTE)
Treatment – Surgery -4
Cornerstone of therapy.
Goal to achieve cure, avoidance of local recurrence, maximize function and minimize morbidity
Achieve 2 cm margin in all directions.
Failure to achieve adequate margins equals local recurrence rate between 50 and 90%.
Treatment – radiation -2
Used as adjuvant or neoadjuvant.
Goal decrease the need for radical excision to maintain functionality and decrease cosmetic deformity or as an alternative to amputation.
Treatment – radiation toxicity -6
Bone tissue damage,
bone fracture,
edema,
fibrosis,
functional impairment,
impaired wound healing.
Treatment – radiation modalities -4
Post operative external beam radiotherapy,
adjuvant Brachytherapy,
intraoperative radiation,
pre-operative external beam radiotherapy
Chemotherapy – neoadjuvant -6
Unclear benefit.
Goal avoid aggressive surgery or amputation.
- Decrease tumor size prior to surgery allowing for less extensive surgery
- treating micro metastatic disease earlier in disease course prior to development of drug resistance
- administering chemotherapy prior to surgery induced damage to the local vasculature surrounding the tumor site
- discerning pathological tumor response to chemotherapy following resection
Chemotherapy – adjuvant Doxorubicin-containing chemo regimen -3
meta-analysis - Improved local and distant recurrence – free survival, overall recurrence – free survival.
meta-analysis - Trend towards improving overall survival but NS, others show inc OS
phase III - no OS benefit, similar recurrence free survival
NO CLEAR DATA - make decision based on patient, location, and type of tumor FOR BOTH NEOADJ AND ADJ
Metastatic disease concepts -6
Half of patients will relapse with disease at a distance site.
Chemotherapy for palliation.
Median survival one year.
Response to chemo is poor about 10 to 20%.
Combination chemotherapy common (inc response) but does NOT increase OS
DOXORUBICIN considered to be most active
Metastatic disease – factors predicting favorable response -5
Performance status,
lack of hepatic involvement,
low grade histology,
long disease free survival from diagnosis,
age.
Metastatic disease – intra-arterial chemotherapy
No proven benefit over systemic Chemotherapy
optimize drug concentration at tumor site
Metastatic disease – chemotherapy choices -7
Doxorubicin 75mg/m2– RR – 20%. PLD 50mg/m2 Ifosfamide – 15 to 20% dacarbazine – 15 to 20% Cisplatin – 15% Epirubicin 75– 15% cyclophosphamide – 10% actinomycin D – 15%
Metastatic disease – limb perfusion therapy - what is it? toxicity? -5
use of tourniquet to isolate blood flow in area of tumor
Melphalan + tumor necrosis factor.
No data to assess efficacy!! no comparison with systemic tx
Toxicity:
Functional impairment from local tissue and muscle damage,
Edema,
thromboembolic disease.
Metastatic disease – Doxil versus doxorubicin -3
Same response rate but different toxicities.
Doxil: Palmer – planter erythrodyesethesia 50% vs 0% for doxo.
Doxorubicin: Grade 3/4 neutropenia 77%, Doxil 6%
Kaposi’s sarcoma - Treatment options -6
Lots of treatment options.
Local: Radiotherapy – 85% CR.
Surgery – 56% with no recurrence after resection.
Systemic: HAART – 22%.
Oral etoposide 74%.
PLD
