WD/DD LPS usually arises in the abdomen, while other LPS subtypes mainly have an extra-abdominal origin. With the lack of prospective data on anthracycline-based CT in advanced WD/DD LPS, we conducted a retrospective analysis of the activity of cytotoxic regimens in patients (pts) with LPS of intrabdominal origin (IA-LPS) who had entered EORTC/STBSG clinical studies, assuming that the vast majority of LPS at this location are WD/DD LPS.
We searched for all adult pts treated with first-line CT for advanced IA-LPS in EORTC/STBSG phase II-III trials from 1970. Treatment was aggregated into 5 groups: anthracycline (A) alone (Doxorubicin (D) 75 mg/m2, Caelyx 50 mg/m2, Epirubicin 75 mg/m2, Epirubicin 150 mg/m2), Ifosfamide (IFO) alone (IFO 5 g/m2, IFO 9 g/m2, IFO 12 g/m2), D+IFO (D 50 mg/m2+IFO 5 g/m2, D 75 mg/m2+IFO 5 g/m2, DOX 75 mg/m2+IFO 10 g/m2), D+cyclophosphamide+vincristine+DTIC (CYVADIC), “other” (brostallicin, trabectedin). Response was assessed by RECIST or WHO criteria. Progression-free survival (PFS) and overall survival (OS) were computed by Kaplan-Meier method.
109 IA-LPS pts from 13 trials, enrolled between 1978 and 2012, were identified (median age 57 yrs). Overall, there were 10/109 (9.2%) responders to CT:
Response Treatment Total (N=109) A alone (N=48) IFO alone (N=15) D+IFO (N=18) CYVADIC (N=8) Other (N=20) CR 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) PR 3 (6.3) 2 (13.3) 4 (22.2) 1 (12.5) 0 (0.0) 10 (9.2) SD 24 (50.0) 10 (66.7) 5 (27.8) 4 (50.0) 14 (70.0) 57 (52.3) PD 20 (41.7) 3 (20.0) 6 (33.3) 3 (37.5) 6 (30.0) 38 (34.9) Not evaluable 1 (2.1) 0 (0.0) 3 (16.7) 0 (0.0) 0 (0.0) 4 (3.7)
At 10-mo median follow-up (IQR 6-24), m-OS was 19 mos (95%CI 15-21), m-PFS 4 mos (95%CI 3-6). D+IFO achieved a not statistically significant longer m-PFS (12 mos) and m-OS (31 mos) than observed with other regimens. Univariate and multivariate analysis of response to CT did not identify prognostic factors.
Cytotoxic CT, in particular D alone, had limited activity in advanced IA-LPS. Though IFO-containing regimens showed higher activity compared to A alone in a small number of cases. This series provides a benchmark for future trials on new drugs in WD/DD LPS.
EORTC Soft Tissue and Bone Sarcoma Group.
Has not received any funding.
S. Stacchiotti, B. Kasper: Honoraria (self), Research grant/Funding (institution), Travel/Accommodation/Expenses: Pharmamar. R. Sanfilippo: Research grant/Funding (institution), Travel/Accommodation/Expenses: Pharmamar. All other authors have declared no conflicts of interest.