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Martin-Broto J, Olarte-García A, Fernandéz-Rodríguez R, Ferreira MR, Carrasco-García I, Galvez-Montosa F, Rincon-Perez I, Peinado-Serrano J, Azinovic I, Guzman-Gomez L, Salgado L, Sevillano A, Ortega J, Alvarez C, Gutierrez A, Moura DS, Hindi N. Trabectedin and low-dose radiation therapy in patients with advanced leiomyosarcoma. Ther Adv Med Oncol 2024; 16:17588359231225044. [PMID: 38288156 PMCID: PMC10823838 DOI: 10.1177/17588359231225044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/05/2023] [Indexed: 01/31/2024] Open
Abstract
Background and objectives Dimensional response is an unmet need in second lines of advanced soft tissue sarcomas (STS). Indeed, the three approved drugs, pazopanib, trabectedin, and eribulin, achieved an overall response rate (ORR) of less than 10%. This fact potentially hinders the options for fast symptomatic relief or surgical rescue. The combination of trabectedin plus low-dose radiation therapy (T-XRT) demonstrated a response rate of 60% in phase I/II trial, while real-life data achieved 32.5% ORR, probably due to a more relaxed timing between treatments. These results were obtained in progressing and advanced STS. In this study, the merged databases (trial plus real life) have been analyzed, with a special focus on leiomyosarcoma patients. Design and methods As responses were seen in a wide range of sarcoma histologies (11), this study planned to analyze whether leiomyosarcoma, the largest subtype with 26 cases (30.6%) in this series, exhibited a better clinical outcome with this therapeutic strategy. In addition, four advanced and progressing leiomyosarcoma patients, all with extraordinarily long progression-free survival of over 18 months, were collected. Results A total of 847 cycles of trabectedin were administered to 85 patients, with the median number of cycles per patient being 7 (1-45+). A trend toward a longer progression-free survival (PFS) was observed in leiomyosarcoma patients with median PFS (mPFS) of 9.9 months [95% confidence interval (CI): 1.1-18.7] versus 5.6 months (95% CI: 3.2-7.9) for the remaining histologies, p = 0.25. When leiomyosarcoma and liposarcoma were grouped, this difference reached statistical significance, probably due to the special sensitivity of myxoid liposarcoma. The mPFS for L-sarcomas was 12.7 months (95% CI: 7-18.5) versus 4.3 months (95% CI: 3.3-5.3) for the remaining histologies, p = 0.001. Cases with long-lasting disease control are detected among leiomyosarcoma patients. Conclusion Even when extraordinarily long-lasting responses do exist among leiomyosarcoma patients treated with T-XR, we were unable to demonstrate a significant difference favoring leiomyosarcoma patients in clinical outcomes.
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Affiliation(s)
- Javier Martin-Broto
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, Av. de los Reyes Católicos, 2, Madrid 28040, Spain
- University Hospital General de Villalba, Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jimenez Diaz, La Universidad Autónoma de Madrid, Madrid, Spain
| | - Alicia Olarte-García
- Radiation Oncology Service, Instituto Oncológico, Clínica IMQ Zorrotzaurre, Bilbao, Spain
| | | | - Marta Ribeiro Ferreira
- Medical Oncology Department, Instituto Português de Oncologia do Porto FG, Porto, Portugal
| | | | | | | | - Javier Peinado-Serrano
- Department of Radiation Oncology, University Hospital Virgen del Rocío, Sevilla, Spain
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Consejo Superior de Investigaciones Científicas, Universidad de Sevilla, Seville, Spain
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio Azinovic
- Department of Radiation Oncology, Fundación Jimenez Diaz University Hospital, Madrid, Spain
| | - Laura Guzman-Gomez
- Department of Radiation Oncology, Fundación Jimenez Diaz University Hospital, Madrid, Spain
| | - Lurdes Salgado
- Radiotherapy Department, Instituto Português de Oncologia do Porto FG, Porto, Portugal
| | - Alberto Sevillano
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, Madrid, Spain
- University Hospital General de Villalba, Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jimenez Diaz, La Universidad Autónoma de Madrid, Madrid, Spain
| | - Justo Ortega
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, Madrid, Spain
- University Hospital General de Villalba, Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jimenez Diaz, La Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Antonio Gutierrez
- Medical Hematology Department, Son Espases University Hospital, Mallorca, Spain
| | - David S. Moura
- Instituto de Investigación Sanitaria Fundación Jimenez Diaz, La Universidad Autónoma de Madrid, Madrid, Spain
| | - Nadia Hindi
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, Madrid, Spain
- University Hospital General de Villalba, Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jimenez Diaz, La Universidad Autónoma de Madrid, Madrid, Spain
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