Adult Soft tissue sarcomas - OncologyPRO · Adult Soft tissue sarcomas. Paolo G. Casali. [email protected]. Empl Cons Stocks Speaker Res Test Other. Amgen Domp ...
Feb 07, 2021
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Adult Soft tissue sarcomas
Paolo G. [email protected]
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Empl Cons Stocks Speaker Res Test Other
Amgen Dompé Arog Bayer Blueprint Medicine Daiichi Sankyo Ph. Deciphera Pharmaceuticals Eisai Eli Lilly Epizyme Inc. Novartis Pfizer PharmaMar
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Adult soft tissue sarcomas
Gastrointestinal stromal tumors (GIST)
«Paediatric» sarcomas
«Rare» bone sarcomas
osteosarcoma Ewing sarcoma
chondrosarcoma chordoma …….
liposarcoma leiomyosarcoma
rhabdomyosarcoma
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Adult soft tissue sarcomas
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STS – localized
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STS – localized
operablelocalized
grading
surgerysurgery
+ RT
low high
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STS – localized
operablelocalized
grading
surgerysurgery
+ RT
low highrisk
moderate
high
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STS – localized
operablelocalized
grading
surgerysurgery
+ RT
neoadj CT+ RT
low highrisk
moderate
high
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Cancer 2008;113:573
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Lancet Oncol 2012;13:1045
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Frustaci S et al. J Clin Oncol 2001;19:1238
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STS: surgery
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3 courses CT (E.I.) + RT (50 Gy)
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Free flaps…
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Nerve graft…
preop RT (50 Gy)
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Vascular grafts…
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J Clin Oncol 2012;30:850
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R
epiADM 120 mg/sqm + IFX 9 g/sqm x 3
histology-driven chemo x 3 leiomyosa: GEM + DTIC myxoid lipo: Trabectedin synovial sa: HD-IFX MPNST: IFX + VP16 pleomorphic: GEM + TAX
Limb & sup. trunk STS:ISG-GEIS-FSG adjuvant trial
high grade deeply seated >5 cm
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Lancet Oncol 2017;18:812
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Lancet Oncol 2017;18:812
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S W
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Adjuvant,neoadjuvant & cytoreductive
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STS – metastatic:isolated pulmonary lesions
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STS – metastatic: isolated pulmonary metastasis
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STS – metastatic:isolated pulmonary lesions
resectableIsolated
lung lesions
prognosticfactors unfavourable
favourable
surgery
CT surgery
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Josef Weinlechner1829 - 1906
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SURG
CT
Iterative surgery
cureSURG
CT
cureSURG
CT
cure
…….
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SURG
CT
1 yr?
Iterative surgery
SURG
CT
1 yr?
1 yr?
…….
CT
1 yr?
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STS – metastatic
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STS – metastatic
ADM
ADM + IFX
ADM + Olaratumab
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RADM 75 mg/sqm + IFX 7.5 g/sqm
ADM 75 mg/sqm
EORTCSoft Tissue & Bone Sarcoma Group
STS: advanced disease
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Lancet Oncol 2014;15:415
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Lancet 2016;388:488
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Lancet 2016;388:488
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S W
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STS – metastatic:further-line chemotherapy
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histology-driven therapy
best supportive care
STS – metastatic:further-line chemotherapy
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J Clin Oncol 2016;34:786
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Mol Cancer Therap 2009;8:449
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The Oncologist 2012;17:1213
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Gemcitabine
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Lancet 2012;379:1879
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Lancet 2012;379:1879
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0 cihdIFX x 3
Dedifferentiated liposarcoma:continuous-infusion high-doseIfosfamide
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IFOSFAMIDE7 g/sqm
Mesna7 g/sqm
in Saline up to 250 mL (1,5 mL/h)
x 2 (14 g/sqm in 14 d) / 28 d
cihdIFX
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ADM IFX TRA GEM TAX DTIC IM PAZ REG SUN CERI SOR mTOR CRIZO
Lipo WD-DD
Lipo myxoid
LMS
SS
Angiosa
SFT
DFSP
ASPS
IMT
HE
Histology-driven medical therapy in STS
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S W
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Schaefer I-M et al. J Clin Oncol 2017;36:101
simplecomplex
Cariotype
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Nature 2013;499:214
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Fridman WH et al. Nature Rev 2012;12:299
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Uehara T. BioMed Res Int 2015, #820813
Cancer testis antigens
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Lancet Oncol 2017;18:1493
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Lancet Oncol 2017;18:1493
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Nivolumab
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@casali_pg
Slide Number 1Slide Number 2Slide Number 3Adult soft tissue sarcomasSTS – localizedSTS – localizedSTS – localizedSTS – localizedSlide Number 9Slide Number 10Slide Number 11Slide Number 12STS: surgerySlide Number 14Free flaps…Nerve graft…Vascular grafts…Slide Number 18Limb & sup. trunk STS:�ISG-GEIS-FSG adjuvant trialSlide Number 20Slide Number 21Slide Number 22Adjuvant,�neoadjuvant & cytoreductiveSTS – metastatic:�isolated pulmonary lesionsSTS – metastatic: �isolated pulmonary metastasisSTS – metastatic:�isolated pulmonary lesionsSlide Number 27Slide Number 28Slide Number 29Slide Number 30Slide Number 31Iterative surgeryIterative surgerySTS – metastaticSTS – metastaticSTS: advanced diseaseSlide Number 37Slide Number 38Slide Number 39Slide Number 40Slide Number 41Slide Number 42Slide Number 43Slide Number 44STS – metastatic:�further-line chemotherapySTS – metastatic:�further-line chemotherapySlide Number 47Slide Number 48Slide Number 49Slide Number 50Slide Number 51GemcitabineSlide Number 53Slide Number 54Slide Number 55Slide Number 56Slide Number 57Dedifferentiated liposarcoma:�continuous-infusion high-dose�IfosfamideSlide Number 59Slide Number 60Slide Number 61Histology-driven �medical therapy in STSSlide Number 63CariotypeSlide Number 65Slide Number 66Cancer testis antigensSlide Number 68Slide Number 69Slide Number 70NivolumabSlide Number 72Slide Number 73
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