Adult Soft tissue sarcomas
Paolo G. [email protected]
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
Adult soft tissue sarcomas
Gastrointestinal stromal tumors (GIST)
«Paediatric» sarcomas
«Rare» bone sarcomas
osteosarcoma Ewing sarcoma
chondrosarcoma chordoma …….
liposarcoma leiomyosarcoma
rhabdomyosarcoma
Adult soft tissue sarcomas
STS – localized
STS – localized
operablelocalized
grading
surgerysurgery
+ RT
low high
STS – localized
operablelocalized
grading
surgerysurgery
+ RT
low highrisk
moderate
high
STS – localized
operablelocalized
grading
surgerysurgery
+ RT
neoadj CT+ RT
low highrisk
moderate
high
Cancer 2008;113:573
Lancet Oncol 2012;13:1045
Frustaci S et al. J Clin Oncol 2001;19:1238
STS: surgery
3 courses CT (E.I.) + RT (50 Gy)
Free flaps…
Nerve graft…
preop RT (50 Gy)
Vascular grafts…
J Clin Oncol 2012;30:850
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
Lancet Oncol 2017;18:812
Lancet Oncol 2017;18:812
S W
Adjuvant,neoadjuvant & cytoreductive
STS – metastatic:isolated pulmonary lesions
STS – metastatic: isolated pulmonary metastasis
STS – metastatic:isolated pulmonary lesions
resectableIsolated
lung lesions
prognosticfactors unfavourable
favourable
surgery
CT surgery
Josef Weinlechner1829 - 1906
SURG
CT
Iterative surgery
cureSURG
CT
cureSURG
CT
cure
…….
SURG
CT
1 yr?
Iterative surgery
SURG
CT
1 yr?
1 yr?
…….
CT
1 yr?
STS – metastatic
STS – metastatic
ADM
ADM + IFX
ADM + Olaratumab
RADM 75 mg/sqm + IFX 7.5 g/sqm
ADM 75 mg/sqm
EORTCSoft Tissue & Bone Sarcoma Group
STS: advanced disease
Lancet Oncol 2014;15:415
Lancet 2016;388:488
Lancet 2016;388:488
S W
STS – metastatic:further-line chemotherapy
histology-driven therapy
best supportive care
STS – metastatic:further-line chemotherapy
J Clin Oncol 2016;34:786
Mol Cancer Therap 2009;8:449
The Oncologist 2012;17:1213
Gemcitabine
Lancet 2012;379:1879
Lancet 2012;379:1879
0 cihdIFX x 3
Dedifferentiated liposarcoma:continuous-infusion high-doseIfosfamide
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
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
S W
Schaefer I-M et al. J Clin Oncol 2017;36:101
simplecomplex
Cariotype
Nature 2013;499:214
Fridman WH et al. Nature Rev 2012;12:299
Uehara T. BioMed Res Int 2015, #820813
Cancer testis antigens
Lancet Oncol 2017;18:1493
Lancet Oncol 2017;18:1493
Nivolumab
@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