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

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 January of 2014, he presents to his PCP with complaints of right lower leg pain of several weeks’ duration
• Physical exam was unremarkable except for swelling of the lower right calf; x-ray of the affected leg was negative for fracture
• MRI scan of the lower right calf showed a 20 cm well defined lobular mass arising between the gastrocnemius and soleus
• Biopsy of the mass showed myxoid liposarcoma with round cell component. Patient underwent en bloc resection of the tumor following preoperative radiotherapy
• Gross examination showed the tumor to be 10 × 8 × 15 cm with gelatinous brownish appearance

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.

• In May of 2015, he returns for follow up with intermittent chest and lower back pain; CT scan is consistent with progression of the mediastinal and perinephric masses, and bone scan shows new lesions occurring in the L2 and L3 lumbar vertebrae
• At recurrence, liver and renal function and CBC are within normal limits, and his ECOG performance status is 1
• He received treatment with trabectedin (1.5 mg/m2 24-hr infusion given every 3 week)
• At the 2nd cycle he develops febrile neutropenia (ANC< 500 cells/mm3) requiring hospitalization
• The oncologist reduces his trabectedin dose to 1.2 mg/m2; he continues therapy
• Within 1 week, he shows clinical improvement and CT scan shows slight improvement