ONCAlert | 2018 ASCO Annual Meeting
Soft Tissue Sarcoma Case Studies

Shreyaskumar R. Patel, MD: Additional Chemotherapy in This Patient

Shreyaskumar R. Patel, MD
Published Online:Dec 21, 2015
Rachel F is a 58-year-old school teacher from Roanoke, Virginia. Her medical history is notable for mild hypertension and total knee replacement in 2011

Soft Tissue Sarcoma with Jonathan C. Trent, MD, PhD and Shreyaskumar R. Patel, MD: Case 1

Soft Tissue Sarcoma with Jonathan C. Trent, MD, PhD and Shreyaskumar R. Patel, MD: Case 1
Soft Tissue Sarcoma with Jonathan C. Trent, MD, PhD and Shreyaskumar R. Patel, MD: Case 2

 

Would you consider additional chemotherapy in this patient?

 

The patient has gone through a combination of gemcitabine and docetaxel in the frontline and adriamycin and dacarbazine as the second-line regimen. The patient also had pazopanib as the targeted therapy in the third line. Important things to address at this time, and it should be a mutual decision between the patient family and the treating team on what the goals are, are that this patient has an incurable tumor and fourth-line and beyond therapies are going to have marginal benefit that are not likely to be durable. The choice as to whether one would offer therapy or not becomes a mutual decision.

 

There are patients who will understand that the risks outweigh the benefits, but would still like to try something, and for that patient in this setting, where biochemical parameters are within the acceptable, normal range and performance status is about 2, there may well be options. Whether the patient chooses to exercise those options or not depends on a complex set of events, being personal, logistic, and medical.

CASE: Soft-Tissue Sarcoma (Part 1)

Rachel F is a 58-year-old school teacher from Roanoke, Virginia. Her medical history is notable for mild hypertension and total knee replacement in 2011

  • In March of 2013, she presented to her PCP with abdominal fullness and distension of several months’ duration; physical exam showed mild abdominal discomfort on palpation; she denied any recent weight loss
  • Initial abdominal sonography was inconclusive; subsequent CT scan showed a heterogeneously enhancing retroperitoneal mass along segment I of the inferior vena cava (IVC) and central necrosis
  • She underwent contrast-enhanced CT with coronal and sagittal reconstructions, which showed encasement of the aorta and multiple hepatic metastases
  • CT guided biopsy of the mass showed leiomyosarcoma that was immunohistochemically positive for desmin, smooth muscle actin, and vimentin, with a high proliferative rate (Ki67 > 60%)
  • She underwent chemotherapy with gemcitabine and docetaxel for a total of 6 cycles, and experienced a minor response. Therapy was discontinued however, in November 2013 due to cumulative toxicity

Follow-up CT scan in January 2014 showed progression at multiple sites; at the time of follow up, her ECOG performance status was 1, with renal and hepatic function within normal limits

  • She underwent six cycles of chemotherapy with anthracycline and dacarbazine, and her disease stabilized

In September of 2014 she returns for follow-up, unable to work with increasing fatigue and abdominal pain, and her CT scan was consistent with progressive disease

  • She received treatment with pazopanib at 800 mg daily for metastatic disease
  • Patient tolerated the treatment well, with mild fatigue and diarrhea, and her symptoms improved

After 4 months of therapy, she presents with worsening abdominal pain and declining performance status

  • CT showed extensive progression of the primary tumor and hepatic metastases
  • At progression, CBC, liver, and renal function were within normal limits, ECOG performance status was 2
Publications
Copyright © TargetedOnc 2018 Intellisphere, LLC. All Rights Reserved.