Defining the role of neoadjuvant systemic therapy in high‐risk retroperitoneal sarcoma: A multi‐institutional study from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group

Cancer ◽  
2020 ◽  
Author(s):  
William W. Tseng ◽  
Francesco Barretta ◽  
Lorenzo Conti ◽  
Giovanni Grignani ◽  
Francesco Tolomeo ◽  
...  
Keyword(s):  
High Risk ◽  
Systemic Therapy ◽  
Working Group ◽  
Retroperitoneal Sarcoma ◽  
Neoadjuvant Systemic Therapy

Defining the role of neoadjuvant systemic therapy in high-risk retroperitoneal sarcoma: A multi-institutional TARPSWG study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 11513-11513 ◽  
Author(s):  
William W. Tseng ◽  
Francesco Barretta ◽  
Lorenzo Conti ◽  
Giovanni Grignani ◽  
Francesco Tolomeo ◽  
...  
Keyword(s):  
High Risk ◽  
Systemic Therapy ◽  
Statistical Significance ◽  
Objective Response ◽  
Logistic Models ◽  
Major Complication ◽  
Retroperitoneal Sarcoma ◽  
Recurrence Rates ◽  
Pleomorphic Sarcoma ◽  
Neoadjuvant Systemic Therapy

11513 Background: Surgery is the mainstay of treatment for patients with retroperitoneal sarcoma (RPS), but this can be challenging, and recurrence rates are high. Novel treatment approaches are needed. In this study, we sought to 1) determine the frequency and potential predictors of radiologic tumor response and 2) assess clinical outcomes in patients with primary high risk RPS who were treated at sarcoma referral centers with neoadjuvant systemic therapy followed by surgery. Methods: Clinicopathologic data was retrospectively collected for eligible patients treated from 2008-2018 at 13 institutions within the Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG). For each patient, preoperative objective response (RECIST1.1) was reported by each institution. Univariable and multivariable logistic models were performed to determine predictors of response. Kaplan-Meier plots were constructed for overall survival (OS) and cumulative incidences of local recurrence (LR) and distant metastasis (DM). Results: In total, 158 RPS patients were included in this study. A median of 3 cycles (IQ range 2-4) of neoadjuvant systemic therapy were given. No complete responses were observed. Partial response (PR) was seen in 37 patients (23%), stable disease (SD) in 88 (56%) and progressive disease (PD) in 33 (21%). Subtype-specific differences were seen including PR in 5 out of 11 (45%) patients with undifferentiated pleomorphic sarcoma. Overall, higher number of cycles given was positively associated with PR (p = 0.005). No other factors including receipt of neoadjuvant radiation therapy were predictive of PR. All patients underwent complete (R0/R1) resection with a major complication (Clavien-Dindo ≥3) rate of 23%. Differences in OS were observed based on preoperative response type (p = 0.005). In grade 3 dedifferentiated liposarcoma, patients who received adriamycin-ifosfamide versus another regimen had decreased LR and improved OS. In leiomyosarcoma, patients who received adriamycin-DTIC versus another regimen had a higher PR rate (37% vs. 16%), decreased LR, DM and improved OS. Limited by low numbers, these subtype-specific data did not reach statistical significance. Conclusions: In patients with high risk RPS, response to neoadjuvant systemic therapy is overall modest and may be regarded as an indicator of disease biology to predict survival after surgery. Subtype-specific regimens should be further validated and incorporated into prospective trials of neoadjuvant systemic therapy in RPS (e.g. STRASS2).

Neoadjuvant Systemic Therapy for High-Risk Melanoma Patients

2020 ◽  
pp. 767-793
Author(s):  
Emily Z. Keung ◽  
Rodabe N. Amaria ◽  
Vernon K. Sondak ◽  
Merrick I. Ross ◽  
John M. Kirkwood ◽  
...  
Keyword(s):  
High Risk ◽  
Systemic Therapy ◽  
High Risk Melanoma ◽  
Risk Melanoma ◽  
Neoadjuvant Systemic Therapy ◽  
Melanoma Patients

scholarly journals Neoadjuvant Systemic Treatment of Primary Angiosarcoma

Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2251
Author(s):  
Kimberley M. Heinhuis ◽  
Nikki S. IJzerman ◽  
Winette T. A. van der Graaf ◽  
Jan Martijn Kerst ◽  
Yvonne Schrage ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Systemic Therapy ◽  
Case Reports ◽  
Standard Of Care ◽  
Cochrane Library ◽  
Resection Margins ◽  
Term Survival ◽  
Primary Angiosarcoma ◽  
Neoadjuvant Systemic Therapy

Angiosarcoma is an extremely rare and aggressive malignancy. Standard of care of localized tumors includes surgery ± radiation. Despite this multimodal treatment, >50% of the angiosarcoma patients develop local or distant recurrent disease. The role of neoadjuvant systemic therapy is still controversial and we therefore performed a systematic review of the literature to define the role of neoadjuvant systemic therapy based on available evidence. We focused on the effects of neoadjuvant systemic therapy on: 1. The success of surgical resection and 2. the long-term survival. All articles published before October 2019 on Ovid Medline, Ovid Embase, Cochrane library and Scopus were evaluated. Eighteen case reports and six retrospective cohort studies were included. There were no randomized controlled trials. This literature showed a beneficial role of neoadjuvant chemotherapy on downsizing of the tumor resulting in an improvement of the resection margins, especially in patients with cardiac or cutaneous angiosarcoma. However, no definitive conclusions on survival can be drawn based on the available literature lacking any prospective randomized studies in this setting. We advise that neoadjuvant chemotherapy should be considered, since this could lead to less mutilating resections and a higher rate of free resection margins. An international angiosarcoma registry could help to develop guidelines for this rare disease.

Neoadjuvant Systemic Therapy for High-Risk Melanoma Patients

2018 ◽  
pp. 1-27
Author(s):  
Emily Z. Keung ◽  
Rodabe N. Amaria ◽  
Vernon K. Sondak ◽  
Merrick I. Ross ◽  
John M. Kirkwood ◽  
...  
Keyword(s):  
High Risk ◽  
Systemic Therapy ◽  
High Risk Melanoma ◽  
Risk Melanoma ◽  
Neoadjuvant Systemic Therapy ◽  
Melanoma Patients

scholarly journals P1.12-02 Nationwide Assessment of the Role of Adjuvant Systemic Therapy in High-Risk Lung Carcinoids

2019 ◽  
Vol 14 (10) ◽  
pp. S534
Author(s):  
M. Kamel ◽  
A. Sholi ◽  
A. Naik ◽  
S. Harrison ◽  
B. Lee ◽  
...  
Keyword(s):  
High Risk ◽  
Systemic Therapy ◽  
Adjuvant Systemic Therapy

Effect of neoadjuvant systemic therapy prior to radical prostatectomy in high-risk prostate cancer on surgical morbidity: Contemporary results utilizing the Clavien System.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 66-66
Author(s):  
Stephen Bentley Williams ◽  
John W. Davis ◽  
Mary F. Achim ◽  
Amado J. Zurita ◽  
Surena F. Matin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Systemic Therapy ◽  
Preoperative Hemoglobin ◽  
High Risk Prostate Cancer ◽  
Estimated Blood Loss ◽  
Neoadjuvant Systemic Therapy ◽  
Risk Prostate Cancer ◽  
Grade 3

66 Background: There is limited evidence definingthe morbidity of radical prostatectomy (RP) with curative intent for patients with high risk prostate cancer. Multimodality treatment for men with high risk prostate cancer using neoadjuvant systemic therapy followed by surgery is being increasingly explored. Methods: We analyzed 215 consecutive patients with high risk and very high risk prostate cancer who underwent robotic or open RP with extended pelvic lymph node dissection previously untreated or received neoadjuvant systemic therapy between 2006 and 2010 at a single tertiary care academic center. Univariable and multivariable logistic regression analyses were used to identify predictors of complications. Results: Baseline characteristics were similar between patients who underwent neoadjuvant systemic therapy followed by RP versus RP alone except for PSA (PSA< or equal to 4 ng/ml: 75.4% vs. 15.5%, p<0.001) and preoperative hemoglobin (13.8 g/dl vs. 14.4 g/dl, p=0.003), respectively. Twenty nine percent of patients (63 of 215 patients) experienced a complication of any grade ≤90 d after surgery 6% experienced Grade ≥3, with no significant difference between either cohort (p=0.50). On multivariate analysis, estimated blood loss [Odds Ratio (OR) 1.10; 95% CI, 1.0 to 1.2, p=0.03), length of stay (OR 1.75; 95% CI, 1.3 to 2.4, p=0.001) and preoperative hemoglobin (OR 0.71; 95% CI, 0.53 to 0.94, p=0.02) were independent predictors of the occurrence of any grade complication. Considering grade 3 or 4 complications, procedure time (OR 2.20; 95% CI 1.0 to 4.8, p=0.05) and estimated blood loss (OR 1.39; 95% CI, 0.98 to 1.96, p=0.06) were significant predictors of major complications. Conclusions: Postoperative morbidity in patients with high risk prostate cancer following RP with or without the use of neoadjuvant systemic therapy is comparable to contemporary RP series of low to intermediate risk disease reporting outcomes in a similar fashion. Use of neoadjuvant systemic therapy prior to RP was safe and did not appear to increase the risk of having a perioperative complication.

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