Annual Meeting Proceedings Part 1 - American Society of Clinical ...

10060 General Poster Session (Board #49E), Sun, 8:00 AM-12:00 PM
Treatment outcomes of primary mediastinal and intrathoracic great vessels
sarcoma: Royal Marsden Hospital experience. Presenting Author: Shir
Kiong Lu, Sarcoma Unit, Royal Marsden NHS Foundation Trust, London,
United Kingdom
Background: Sarcoma of the mediastinum and great vessels remain a rare
subgroup of soft tissue sarcoma and prognosis remains poor with patients
(pts) often presenting with advanced disease. There is no standard
treatment due to paucity of data hence its management relies on case
series. To date this is the largest series of pts reported. Methods:
Retrospective analysis of pts identified anonymously from a prospectively
maintained database of the sarcoma unit. Results: 46 pts were included in
the analysis. The median age at diagnosis was 45.9 with a male: female
ratio of 1.2: 1. 60% of pts presented with localised disease. The most
common histological subtype was spindle cell sarcoma followed by angiosarcoma.
The heart (n�21), majority in the atria, was the commonest
primary site. 28 pts presented with localised disease of which 21 had
surgery and 16 received chemotherapy (CT). 4 pts received multi-modality
treatment. 83% of pts with metastases had CT. 6 of them attained stable
disease, 1 had partial response and 4 (Ewing’s, rhabdomyosarcoma and
angiosarcoma) had complete response. 31 pts developed disease recurrence
of which 58% had initial localised disease. 6 pts had metastectomy,
19 received palliative CT and 11 had palliative radiotherapy (RT). RT of
50-60Gy to the heart or mediastinum was delivered to 61% of pts with
initial localized disease and 33% of pts with metastases. 2 pts had
documented post-treatment cardiac complication. After a median follow up
of 2.16 years, the median event-free survival was 0.97 years (95%CI
0.65-1.30), median overall survival (OS) was 1.7 years (95% CI 0.70-
2.71) and 5 year OS was 17.9%. Conclusions: The optimal management in
this disease is unclear. In this study, surgery was frequently implemented
in both localised and metastatic settings but challenges remain in
achieving clear margins. Chemotherapy has a role and it is key to identify
chemosensitive subtypes. RT is offered as an adjunct following suboptimal
resection. Despite aggressive treatments, this group of young pts had high
recurrence rate and poor prognosis. Multi-modality treatment may have a
role in selected pts but its efficacy and long-term cardiac sequelae need to
be evaluated prospectively.
10062 General Poster Session (Board #49G), Sun, 8:00 AM-12:00 PM
Rechallenge with trabectedin in patients with locally advanced or metastatic
soft tissue sarcoma following drug holiday: The experience of the
French Sarcoma Group (FSG). Presenting Author: Esma Saada, Centre
Antoine Lacassagne, Nice, France
Background: Trabectedin (T) is a marine-derived alkaloid used to treat
advanced soft tissue sarcomas (STS) after ifosfamide and/or anthracyclins
failure. Since then, the FSG evaluated the clinical benefit in readministrating
T after an initial hold, either medically indicated or upon
patient’s request. Methods: Following an online request, clinical and
histopathological data were collected from six centers of the FSG who
declared to have rechallenged patients. Baseline data were collected and
analyze will be used. Results: From 1999 to 2011, 49 pts with T drug
holiday have been identified (26 male/ 23 female), with a median age of 50
y [23-75]. Most frequent histotypes were: myxoid liposarcoma (18,
36.7%), leiomyosarcomas (13, 26.5 %) and well-differentiated/dedifferentiated
liposarcoma (9, 18%). WHO grade were 1 in 14 (29%), 2 in 19
(39%) and 3 in 5 (10%) pts respectively. Patients who had a maximum of
2, 3 or 4 therapeutic sequences (TS) with T (drug-holiday and rechallenge)
were 41/49 ,7/49 and 1/49 respectively. Median number of cycles for 1, 2,
3 and 4 TS were 7 [3-21], 6 [2-30], 6 [2-9] and 6. Median total number of
cycles was 15 [6-43]. Median duration of drug-holiday for 1, 2 and 3 TS
were 11 [3-91], 7 [2-29] and 4 months [1-5]. Grade 3-4 toxicities
incidence decreased with the number of TS (occurred in 36%, 29%, 14%
and 0% of pts with 1, 2, 3 and 4 TS) as well as mean T dose per cycle (1.3
mg/m², 1.2 mg/m², 1.1 mg/m² and 1.1 mg/m² for TS 1, 2, 3, 4). Efficacy
decreased with number of TS (Number of CR/PR/SD/PD were 1 (2%)/15
(31%)/33 (67%)/0 for TS1; 0/4 (8%)/29 (59%)/16 (3%) for TS2; 0/1
(14%)/2 (29%)/4 (57%) for TS3 and 0/0/0/1(100%) for TS4). Median
overall survival was 5.0 y [2.7-7.3] since T introduction, and 1.5 y
[0.1-4.8], 0.8 y [0.5-1.3] and 0.6 y following 2nd , 3rd and 4th T
reintroduction respectively. Objective response after TS2 were seen in 4
cases of grade 1 sarcomas. Conclusions: Due to the lack of cumulative
toxicities over time with T, its rechallenging in responding patients to T (no
progression under T) have to be considered in advanced STS.
Sarcoma
645s
10061 General Poster Session (Board #49F), Sun, 8:00 AM-12:00 PM
Drug treatment (tx) patterns and survival among patients (pts) with metastatic or
recurrent soft tissue sarcoma (m/rSTS) refractory to at least one prior therapy.
Presenting Author: Michael Wagner, Dana-Farber Cancer Institute/Harvard
Medical School, Boston, MA
Background: Limited clinical data on real-world practice patterns are available for
care of pts with m/rSTS. This study evaluated drug tx patterns and outcomes in
m/rSTS pts following failure of prior chemotherapy based on data from a U.S.
referral academic cancer center. Methods: Data from medical records consented
for research use were retrospectively reviewed at Dana-Farber Cancer Institute
for pts with m/rSTS who were �18 years, commenced 2nd-line systemic therapy
between 1/1/2000 and 2/4/2011, had confirmed disease progression on or after
1st-line therapy and had �3 months of observation. Pts were excluded if they
had been diagnosed with gastrointestinal stromal tumor, bone sarcoma or
dermatofibrosarcoma protuberans, or had ever been treated with pazopanib.
Histologic subtype, tx type and duration, tx modifications (e.g., discontinuation)
and reasons for modifications were examined. Overall survival, time to progression
and clinician-assessed tumor response were collected. Results: Study pts
had leiomyosarcoma (n�50), synovial cell sarcoma (n�7), liposarcoma (n�5)
and other histologic subtypes (n�39). These 101 pts received an average 4 lines
of tx (maximum�10 lines). Wide variations were noted in each line of tx (Table)
with no consistent nor dominant regimens. Median 2nd-line tx duration was 4.1
months (95%CI 2.9-5.0). Among 98 pts who discontinued 2nd-line tx, 72
(73%) did so due to progressive disease, 10 due to “completion” of planned tx,
and 6 to adverse events. Median progression-free survival from initiation of
2nd-line tx varied across regimens from 2.0 to 6.5 months (overall median 5.5
months). Conclusions: The wide variation in �2nd-line tx confirms there is no
single “standard” of care for m/rSTS. The majority of pts discontinued 2nd-line
tx due to progressive disease and often received additional lines of tx, indicating
frequent physician and pt switching of tx.
Number pts receiving
Line of AnthracyclineGemcitabine- Alkylating Angio-genesis
therapy basedbased agent inhibitor Trabectedin Total
Taxanebased
Other
txt
1st 44 29 9 5 4 0 10 101
2nd 26 28 12 7 13 3 12 101
3rd 12 12 15 12 16 1 9 77
4th 7 5 13 10 9 1 3 48
5th 0 5 12 5 8 0 2 32
6th 2 2 8 3 2 0 1 18
10063 General Poster Session (Board #49H), Sun, 8:00 AM-12:00 PM
Bone metastases in soft tissue sarcoma patients: A survey of natural,
prognostic value, and treatment. Presenting Author: Bruno Vincenzi,
Università Campus Bio-Medico, Rome, Italy
Background: Given the limited data currently available, we surveyed the
natural history of bone metastases in patients affected by soft tissue
sarcoma (STS). Methods: This retrospective, multicenter, observational
study evaluated data from 135 patients with STS metastatic to the bone
who presented between 2001 and 2011. For all patients, we recorded the
primary tumor histological subtype, bone metastases characteristics (onset,
site), type of treatment received (surgery, radiotherapy, zoledronic
acid), type and frequency of skeletal related events (SRE) and disease
outcome. Results: The most represented histological subtypes among the
enrolled patients were leiomyosarcoma (27%), angiosarcoma (13%) and
spindle cell sarcoma (8%). The spine was the most common site for bone
involvement (51%), followed by hip/pelvis (20%), long bones (15%) and
other sites (14%). In 27% of cases, bone metastases were present at the
time of diagnosis. Fiftyfour patients (40%) developed SREs and the
median time to first SRE (if developed) was 4 months. The most common
SRE was the need for radiotherapy occurring in 28% of patients followed by
pathologic fracture (22%). Patients survived for a median of 6 months after
bone metastases diagnosis. The occurrence of a SRE was associated with a
decreased overall survival (P�0.04). A subgroup analysis revealed that
zoledronic acid significantly prolonged median time to first SRE (5 versus 2
months; P � 0.002). Conversely, It did not determine an improvement in
terms of overall survival, even if favorable trend was identified (median, 7
versus 5 months, respectively; P � 0.105). Conclusions: This study
illustrates the burden of bone disease from STS and supports the use of
zoledronic acid in this setting.
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