How has the recent approval of trabectedin influenced treatment options for patients such as Michael?
Clearly, there has been an unmet need for newer treatments and additional treatments for this group of patients with soft tissue sarcomas. Liposarcomas and leiomyosarcomas happen to be two of the more common subsets of soft tissue sarcomas, and having another drug that’s commercially available and accessible to investigators and treating physicians around the country clearly adds something to the therapeutic armamentarium, specifically for this patient with mixoid liposarcoma where trabectedin seems to have some selective activity for this particular subset, as already documented in this patient. J
ust after the first couple of cycles, there seemed to be some clinical benefit and a radiographic response. So, having effective therapies that may not be curative but certainly can allow us to stretch the longevity out a little longer is very helpful. Remember that this is a group of tumors where survival resection of isolated metastatic lesions has been always incorporated as part of standard of care.
If there is some control of multifocal metastases with a systemic chemotherapeutic agent and the disease site is resectable, one would certainly incorporate consolidation of a response to systemic therapy with surgical resection to render the patient grossly free of disease which may be the first step to remaining free of disease for a little longer and potentially can impact on their longevity and lifespan.
CASE: Soft-Tissue Sarcoma Case 2
Michael C is a 59-year-old social worker from Los Angeles California; his medical history is notable for obesity, COPD, and mild hypertension.
In September of 2014, Michael returns for follow up and his CT scan shows a 4 cm posterior mediastinal mass, and a 6 cm perinephric mass suspicious for metastatic disease. He initiates treatment with anthracycline and ifosfamide chemotherapy (6 cycles) for recurrent disease and shows a partial response.