• Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
REVIEW
Year : 2017  |  Volume : 3  |  Issue : 1  |  Page : 20-28

Current and future systemic treatment options for advanced soft-tissue sarcoma beyond anthracyclines and ifosfamide


Instituto de Biomedicina de Sevilla (IBIS); Department of Medical Oncology, Hospital Universitario Virgen del Rocio, CSIC, Universidad de Sevilla, Seville, Spain

Date of Submission06-Nov-2016
Date of Acceptance04-Jan-2017
Date of Web Publication23-Feb-2017

Correspondence Address:
Nadia Hindi
Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio, CSIC, Universidad de Sevilla, C/Manuel Siurot s/n, 41013 Seville
Spain
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2395-3977.200858

Rights and Permissions
  Abstract 

Sarcomas are rare, life-threatening, malignant tumors. Surgery is the cornerstone of therapy in the localized setting. About one-third of patients develop distant metastasis. In the metastatic setting, systemic therapy is the mainstay of treatment, and several second-line options are available, proving a modest survival increase for these patients. Trabectedin is an active drug with several described mechanisms of action. Although the objective response rate is low, about one-third of patients achieve disease stabilizations and a prolonged disease control. Interestingly, it has no accumulative toxicities. Pazopanib is the only targeted therapy approved for soft-tissue sarcoma (STS), with the exception of adipocytic sarcoma. Eribulin represents a recently approved therapeutic option for liposarcoma. Other drugs such as gemcitabine combinations, dacarbazine, and taxanes have also shown activity in second lines in advanced STS. The selection should be based on histologic subtype, patient characteristics, and toxicity profile among other factors. This review will summarize clinical development of the current and future therapeutic options for this heterogeneous group of diseases.

Keywords: Metastatic disease, sarcoma, systemic therapy, targeted therapy, translational research


How to cite this article:
Hindi N, Martin-Broto J. Current and future systemic treatment options for advanced soft-tissue sarcoma beyond anthracyclines and ifosfamide. Cancer Transl Med 2017;3:20-8

How to cite this URL:
Hindi N, Martin-Broto J. Current and future systemic treatment options for advanced soft-tissue sarcoma beyond anthracyclines and ifosfamide. Cancer Transl Med [serial online] 2017 [cited 2017 Jun 24];3:20-8. Available from: http://www.cancertm.com/text.asp?2017/3/1/20/200858


  Introduction Top


Soft-tissue sarcoma (STS) is a heterogeneous group of more than fifty different subtypes, accounting for < 2% of all solid tumors in adults,[1] with an estimated incidence of 5 new cases per 100,000 per year in Europe.[2] Surgery is the mainstay of therapy in the localized setting.[3] Radiotherapy and chemotherapy are administered in the adjuvant setting when indicated. Despite correct initial local management, about one-third of the patients will eventually develop metastasis and succumb to the disease. Anthracycline-based regimens have been the backbone in STS systemic therapy in the past 30 years, being the drugs used in the adjuvant setting when indicated, and in the first line of advanced disease. Although there is no formal demonstration of the superiority of combination chemotherapy over single-agent doxorubicin in terms of overall survival (OS) in advanced disease,[4] the combination is superior in terms of response and progression-free survival (PFS), being a valuable option when tumor shrinkage is needed to palliate symptoms or in patients with potentially resectable disease. Beside anthracyclines and ifosfamide, there are other approved drugs (trabectedin, pazopanib, and eribulin) in STS and other drugs (dacarbazine, gemcitabine, and taxanes) with activity in this disease. In previous years, due to the greater number of available systemic therapies, the outcome of patients with advanced STS has been improved,[5] achieving a median OS of up to 18 months. The greater background on the molecular pathogenic basis of the different histologic subtypes of STS, and the development of other promising molecules, could improve these results in the future, moving from the all-fits-one approach for a more personalized therapeutic algorithm.


  Current Systemic Options Top


Trabectedin

Trabectedin is an alkaloid originally derived from the marine tunicate Ecteinascidiaturbinata with several described mechanisms of action: interferes with DNA transcription, produces breaks in DNA double helix (activating the homologous recombination DNA repair mechanisms), and also has anti-inflammatory and antiangiogenic activities through tumor-associated macrophages.[6],[7],[8] Many different schedules were used during its clinical development, being 1.5 mg/m2 in 24 h continuous infusion every 21 days in the recommended dose for STS. The principal studies are summarized in [Table 1]. Trabectedin is an active drug in second-line therapy for STS regarding the definition of the European Organisation for Research and Treatment of Cancer (EORTC),[16] consistently showing 6-month progression-free rate (PFR) > 20% (24%–37%) in all clinical trials [Table 1].
Table 1: Trabectedin-based studies in soft-tissue sarcoma

Click here to view


For example, a phase II trial on 54 pretreated sarcoma patients showed 3- and 6-month PFR of 39% and 24%, respectively.[9] In a phase II EORTC study which enrolled 104 previously treated patients, PFS at 3 and 6 months was remarkable (52% and 29%, respectively).[10] Then, a randomized study comparing two schedules of trabectedin on pretreated patients with L-sarcomas (leiomyosarcoma and liposarcoma) was published. One hundred and thirty-four patients received 1.5 mg/m2 in 24 h every 3 weeks and 136 patients received 0.58 mg/m2/week 3 out of 4 weeks. Median PFS was significantly better for the 1.5 mg/m2 every 3-week arm: 3.3 vs. 2.3 months (P = 0.041).[11]

These data resulted in the approval of trabectedin by the European Medicines Agency (EMA) in September 2007 for adult patients with pretreated advanced STS. Recently, the data from a phase III trial comparing trabectedin vs. dacarbazine in advanced L-sarcoma, in which the trabectedin arm showed significantly better PFS (4.2 vs. 1.5 months) with similar OS (12.4 vs. 12.9 months),[12] led to the approval of trabectedin by the Food and Drug Administration (FDA).

Although response rate by the Response Evaluation Criteria in Solid Tumor (RECIST) is low (4%–8%),[9],[10],[13] about one-third of patients achieve disease stabilizations and prolonged disease control. In this sense, it is not uncommon to have experiences of long-responder patients for more than 1 year. The drug has a manageable toxicity profile, with neutropenia, and elevation of transaminases being the most reported G3-4 toxicities. These toxicities, however, are not accumulative and can be reduced with an adequate premedication.[17] Regarding the duration of therapy with trabectedin, a phase II trial from the French sarcoma group (T-DIS study) showed a benefit in terms of PFS (PFS at 6 months 51.9% vs. 23.1%, P = 0.02) for those patients receiving continuous therapy with trabectedin compared with those stopping the therapy and reassuming trabectedin at progression.[18] Based on these results, therapy with trabectedin should be maintained up to progression or intolerance.

As said before, trabectedin could interfere with transcription factors. Many sarcomas are characterized by genetic translocations resulting in fusion proteins, which could work as transcription factors. The activity of trabectedin in translocation-related sarcomas (TRS) was shown in retrospective series with myxoid liposarcoma.[19] A randomized phase II trial on patients with pretreated TRS showed a clear benefit from trabectedin compared with best supportive care (PFS 5.6 vs. 0.9 months, hazard ratio [HR]: 0.07).[14] A randomized phase III study of trabectedin vs. doxorubicin-based chemotherapy as the first-line therapy in patients with TRS showed no significant differences in PFS between the two groups, but this study was underpowered due to a high proportion of patients being censored.[15]

Taking all these results together, trabectedin represents an effective and safe second-line option for all sarcoma subtypes, especially interesting in L-sarcoma.

Pazopanib

Pazopanib is an oral multi-tyrosine kinase inhibitor (TKI), which targets vascular endothelial growth factor receptor (VEGFR-1, VEGFR-2, VEGFR-3), platelet-derived growth factor receptor (PDGFR-α and PDGFR-β), c-Kit, fibroblastic growth factor receptor (FGFR-1, FGFR-2, and FGFR-3), and colony stimulating factor-1 receptor (CSF-1R). The first evidence of activity of pazopanib in sarcoma derives from a phase I trial in solid tumors, in which three patients with sarcoma obtained disease stabilizations lasting more than 6 months. The recommended dose for phase II trial was defined in 800 mg daily.[20] In a subsequent phase II trial (EORTC 62043), 142 patients with advanced pretreated STS were included in four cohorts: adipocytic sarcomas, leiomyosarcoma, synovial sarcoma, and other subtypes. The cohort of adipocytic tumors was closed because activity data did not reach the prespecified threshold. PFS rate at 12 weeks was 44% in leiomyosarcoma, 49% in synovial sarcoma, and 39% in other histologic subtypes. Nine patients (5 of them with synovial sarcoma) experienced a RECIST partial response.[21] These results led to the phase III pivotal PALETTE study,[22] including 372 advanced pretreated sarcoma patients, randomized to pazopanib (800 mg daily) or placebo. The study was positive for its principal objective (PFS), with a median PFS of 4.6 months (95% confidence interval [CI]: 3.7–4.8) in the pazopanib group vs. 1.6 months (95% CI: 0.9–1.8) in the placebo group (HR: 0.31, 95% CI: 0.24–0.40, P < 0.0001). No statistically significant differences in terms of OS were detected: 12.5 months (95% CI: 10.6–14.8) in the pazopanib group vs. 10.7 months (95% CI: 8.7–12.8) in the placebo group (HR: 0.86, 95% CI: 0.67–1.11, P = 0.2514). Fourteen (6%) patients obtained a RECIST partial response, and toxicity profile was predictable, being asthenia (14%), hypertension (7%), transaminases elevation (gammaglutamyl transpeptidase 13%, aspartate transaminase 10%, and alanine transaminase 8%), and anorexia (6%), the most frequent grade 3–4 adverse events. Left ventricular ejection fraction decreased in 6.7% of patients (being symptomatic only in 1%), and 5% of patients experienced deep venous thrombosis. These results enabled the FDA and EMA approval in 2012 of pazopanib for advanced pretreated STS with the exception of liposarcoma. Recently, pazopanib has been tested in adipocytic sarcomas in clinical trials, showing preliminary activity in well-differentiated/dedifferentiated (WD/DD) liposarcoma.[23]

Eribulin

Eribulin mesylate is an antimitotic agent, which acts by inhibiting microtubules' growth.[24] A phase II trial assessed the safety and efficacy of eribulin in pretreated advanced STS. One-hundred and twenty-eight patients received eribulin 1.4 mg/m2 over 2–5 min at days 1 and 8 for every 3 weeks. They were included in four strata: adipocytic sarcoma (37 patients), leiomyosarcoma (40 patients), synovial sarcoma (19 patients), and other sarcomas (32 patients). The study was positive for its primary end point (PFS at 12 weeks) in the group of adipocytic sarcoma with 15 (46.9%) patients were progression free at 12 weeks, and leiomyosarcoma (12-week PFR: 31.6%). The most common grade 3–4 adverse events were neutropenia (52%), anemia (7%), fatigue (7%), and febrile neutropenia (6%).[25] Based on these results, a phase III trial included 452 patients with advanced pretreated adipocytic sarcoma and leiomyosarcoma, which were randomized at 1:1 ratio to receive eribulin (1.4 mg/m2, intravenous [IV] on days 1 and 8) or dacarbazine (850–1200 mg/m2, IV on day 1) for every 21 days. The study was positive for its primary end point (OS). Median OS for eribulin and dacarbazine was 13.5 and 11.5 months, respectively (HR = 0.768, 95% CI: 0.618–0.954; P = 0.017). These differences were significant (15.6 vs. 8.4 months) for liposarcoma, yet not in the leiomyosarcoma cohort.[26] These results led to the FDA approval of eribulin in advanced pretreated liposarcoma in January 2016.[27]

Gemcitabine combinations

Gemcitabine is a nucleoside analog, widely used in the treatment of sarcomas, and its activity has been assessed in several clinical trials [Table 2].[28] Gemcitabine in monotherapy has been tested in both nonselected STS and metastatic leiomyosarcoma. Several schedules have been used, with 1.000 mg/m2 over 30 min on days 1, 8, and 15 for every 28 days being the most used schedule.[29] Fixed-dose rates (FDRs) of infusion of gemcitabine at 10 mg/m2/min are used in clinical trials on sarcoma, based on its higher efficacy compared to short infusions in carcinomas.[36],[37] Gemcitabine monotherapy 1.000 mg/m2 at FDR in leiomyosarcoma resulted in 3-month PFR of 57% and 68% in nonuterine and uterine leiomyosarcoma, respectively.[30]
Table 2: Gemcitabine-based studies in soft-tissue sarcoma

Click here to view


Combinations of gemcitabine have also been tested. The activity of the combination of gemcitabine 900 mg/m2 on days 1 and 8 plus docetaxel 100 mg/m2 on day 8 has been assessed in pretreated advanced uterine and soft-tissue leiomyosarcoma in several small phase II trials. This regimen was considered active [16] for leiomyosarcoma arising at all locations although women with uterine leiomyosarcoma seemed to benefit more: the 3-month PFR for patients with uterine leiomyosarcoma was 70%–75%[30],[31] in contrast to 52% in nonuterine leiomyosarcoma.[30] Data regarding the superiority of the combination with docetaxel vs. gemcitabine alone are conflicting. One phase II randomized trial, conducted in all STS subtypes, showed significantly more objective responses (16% vs. 8%), prolonged PFS (6.2 vs. 3 months) and OS (17.9 vs. 11.5 months), favoring the combination.[32] However, in another phase II trial, enrolling only advanced leiomyosarcoma patients, differences were not found in terms of efficacy, and patients in the combination arm experienced more toxicity.[30]

Gemcitabine-docetaxel is widely used in the USA as upfront line (not pretreated with anthracycline) in many STS, based on the results of a clinical trial in first line,[33] which showed median PFS of 4.4 months in metastatic uterine leiomyosarcoma. Recently, the GeDDiS study did not show superiority of the first-line gemcitabine-docetaxel over doxorubicin alone, neither in terms of PFS nor in OS in a randomized phase III trial.[38]

Another active combination (and synergistic in preclinical experiments) is gemcitabine plus dacarbazine. Two phase II studies developed by the Spanish Sarcoma Group for Research on Sarcoma tested the combination of FDR gemcitabine 1800 mg/m2 and dacarbazine 500 mg/m2 for every 2 weeks.[34],[35] The first study showed the activity of this regimen, showing a 3-month PFR of 48% and a median PFS of 3.9 months. After this study, a randomized phase II trial showed the superiority of the combination over dacarbazine alone (1.200 mg/m2 every 21 days), in terms of 3-month PFR (56% vs. 37%), median PFS (4.2 vs. 2 months), and median OS (16.8 vs. 8.2 months).

Despite the fact that confirmatory phase III trials are lacking, gemcitabine combinations represent an interesting therapeutic option in patients with pretreated STS, especially in leiomyosarcomas, and perhaps in other subtypes as well, such as undifferentiated pleomorphic sarcoma.


  Other Cytotoxic Agents Top


Temozolomide and dacarbazine

Both temozolomide and dacarbazine are alkylating agents, with temozolomide being a prodrug of dacarbazine. Both agents have shown modest activity in monotherapy in pretreated STS.[39],[40] Temozolomide in a prolonged schedule (75–100 mg/m2 per day during 6 consecutive weeks) was tested in 48 patients with pretreated STS.[41] Three-month PFR was 39.5% and RECIST response rate was 15.5%, and interestingly, responding patients maintained response for a long time (median of 12.5 months). Another study with a 5-day schedule of temozolomide in pretreated STS found modest activity of this drug. However, those patients with leiomyosarcoma had a median PFS and OS of 3.9 and 30.8 months, respectively.[42] These drugs could be especially interesting in leiomyosarcoma. Solitary fibrous tumor (SFT) also seems to benefit from dacarbazine- and temozolomide-based regimens.[43],[44]

Paclitaxel

Paclitaxel has shown activity in vascular sarcomas. The French sarcoma group enrolled 30 patients with advanced angiosarcoma in a phase II trial with weekly paclitaxel 80 mg/m2 days 1, 8, and 15, for every 28 days. Four-month PFR was 45%.[45] A subsequent trial from the same group failed to show superiority with the addition of bevacizumab to weekly paclitaxel.[46] This drug is also active in Kaposi sarcoma.[47]

Other targeted therapies in special histologic subtypes

Some infrequent subtypes of STS have shown characteristically specific sensitivity for TKIs: perivascular epithelioid cell tumors with mTOR inhibitors,[48],[49] inflammatory myofibroblastic tumor with crizotinib,[50] dermatofibrosarcoma protuberans and imatinib.[51],[52],[53] Antiangiogenics such as sunitinib and cediranib have shown activity in alveolar soft-part sarcoma,[54],[55] extraskeletal myxoid chondrosarcoma,[56] and SFT.[57],[58]


  Upcoming Drugs Top


Olaratumab

Olaratumab is a human monoclonal antibody that binds the external domain of PDGFR-α, blocking the interaction of the receptor with its ligands (PDGF-AA, PDGF-BB, and PDGFR-CC). PDGFR-α is an interesting target in sarcoma, as overexpression has been demonstrated in several sarcoma subtypes.[59],[60] Olaratumab showed its safety in a phase I trial, without dose-limiting toxicities described.[61],[62] A phase Ib/II trial in combination with doxorubicin was developed in patients with unresectable/advanced STS. Patients received the combination of 75 mg/m2 on day 1 for every 21 days with olaratumab/placebo 15 mg/kg on days 1 and 8 for every 21 days. The trial met its primary end point, showing a longer PFS for the olaratumab arm compared to the placebo arm (6.6 vs. 4.1 months, HR: 0.672). Strikingly, the patients on the combination arm achieved an impressive median OS of 25 vs. 14.7 months in the doxorubicin arm (HR: 0.44, P = 0.0005).[63] Given these results, in September 2016, the EMA has provided a conditional marketing authorization for olaratumab in advanced/metastatic STS. A phase III trial comparing doxorubicin 75 mg/m2vs. doxorubicin 75 mg/m2 plus olaratumab 15 mg/m2 has recently completed recruitment.[64] If these impressive results on OS are confirmed, doxorubicin in monotherapy would no longer be the standard upfront systemic treatment in advanced STS, representing the greatest paradigmatic change in the last three decades in the clinical practice of STS. Olaratumab is also being tested in combination with gemcitabine plus docetaxel in a phase Ib/II ongoing trial.[65]

Palbociclib

Alterations of the cell cycle regulators are a common feature of many neoplasms, including sarcoma.[66] Palbociclib is an oral inhibitor of CDK4/6, already approved in the treatment of hormone receptor-positive metastatic breast cancer in combination with endocrine therapy.[67],[68] The drug has already showed activity in sarcoma. A phase II trial exploring the safety and efficacy of palbociclib in a cohort of 30 patients with pretreated WD/DD liposarcoma (harboring CDK4 amplification and functional Rb) showed a 3-month PFR of 66%, with a median PFS of 18 weeks.[69] Neutropenia was the most frequent toxicity in these patients, being G3 in 43% of the cohort, but only one patient presented febrile neutropenia. Additional preclinical exploration of CDK4/6 inhibition with palbociclib in sarcoma cell lines as well as in xenograft models showed a good correlation between CDK4 overexpression and efficacy of palbociclib in various sarcoma subtypes. Interestingly, overexpression instead of amplification of CDK4 and no overexpression of p16 were good predictive biomarkers for efficacy.[70]

Selinexor

Selinexor is a selective inhibitor of nuclear export (SINE) and acts by binding covalently to human XPO1, a member of the karyopherin b superfamily of nuclear transport proteins.[71] XPO1 facilitates the nuclear export of RNA and proteins such as p53, retinoblastoma, and adenomatous polyposis coli, cell cycle regulators such as p21, and plays a role in mitotic progression and chromosome segregation. Recent preclinical data have shown that selinexor is able to induce apoptosis in liposarcoma and other sarcoma subtypes both in vitro and in vivo.[72] Its safety and the first data on efficacy have been shown in a phase Ib trial in patients with refractory sarcoma, in which 7/15 (47%) of patients with liposarcoma experienced disease stabilization lasting > 4 months.[73] An ongoing phase II/III trial will test its efficacy in advanced liposarcoma (NCT02606461).

Targeting immune system

Immunomodulation is a very topical research field in oncology, and although in sarcoma it is still in an early phase of clinical development, there is evidence to support its potential interest: some of the latest registered drugs in sarcoma, mifamurtide,[74] trabectedin,[8] and pazopanib,[75] have prominent roles in immunomodulation. There is also preclinical evidence suggesting an immune-related effect (mediated by T-cell activation) of doxorubicin efficacy in sarcoma.[76],[77],[78] One of the most well-studied targets in immune-oncology is programed death receptor 1 (PD-1), which has been minimally investigated in sarcoma patients. For other tumor types, expression of PD-1/PD-L1 not only portended a worse prognosis,[79],[80] but also was predictive of response to therapy.[81],[82] Expression of PD-L1 in sarcoma has been demonstrated in several studies, with wide variations among series (12%–58%), suggesting doubts about the reliability of PD-L1 immunostaining.[83],[84] PD-L1 expression has been shown in both translocation and non-TRS: leiomyosarcoma 70%, synovial sarcoma 75%, undifferentiated pleomorphic sarcoma 82%, malignant peripheral nerve sheath tumor 50%, and Ewing sarcoma 67%.[85] Currently, several anti-PD1 compounds are under trial in sarcoma. The preliminary results of a phase II trial with pembrolizumab on unselected sarcomas have shown responses in patients with undifferentiated pleomorphic sarcoma and liposarcoma.[86] Other immunotherapies such as New York esophageal squamous cell carcinoma 1 (NY-ISO) inhibition have been developed in sarcoma. This antigen is expressed in several malignancies and is highly immunogenic.[87],[88] Recent studies have tested the expression of NY-ESO-1 in mesenchymal tumors, showing positivity in 88%–100% of myxoid liposarcoma,[89] 49% of synovial sarcomas, 35% of myxofibrosarcomas, and 28% of conventional chondrosarcomas.[90] Immunotherapy using autologous T-cells retrovirally transduced with an NY-ESO-1-reactive T-cell receptor (TCR) has shown promising results in patients harboring NY-ESO-1-positive synovial sarcoma. In a pilot study with 18 pretreated advanced synovial sarcoma patients, therapy with NY-ESO-1 TCR-transduced T-cells induced objective RECIST responses in 11 patients (61%). One patient even reached a complete radiologic response. Partial responses lasted for 3–18 months, and the estimated overall 3- and 5-year survival rates were 38% and 14%, respectively.[91] In this study, the authors found a correlation between the total number of T-cells and the number of antigen-reactive T-cells administered to patients and the response to therapy, but predictive factors still need to be identified.


  Conclusion Top


There are several active second-line options for patients with advanced STS, and as there are lacking comparative trials addressing the best sequence, the selection should be based on histologic subtype, patient characteristics, and toxicity profile among other factors. Studies focusing on predictive biomarkers are needed in advanced STS. There are several promising drugs in the development of sarcoma, and the increasing knowledge in the molecular background will be helpful to identify new potential therapeutic targets.

Financial support and sponsorship

Nil.

Conflict of interest

There are no conflicts of interest.

 
  References Top

1.
Fletcher CD, Hogendoorn PC, Mertens F, Bridge J, editors. WHO Classification of Tumours of Soft Tissue and Bone. 4th ed. Lyon: IARC Press; 2013.  Back to cited text no. 1
    
2.
Stiller CA, Trama A, Serraino D, Rossi S, Navarro C, Chirlaque MD, Casali GP. Descriptive epidemiology of sarcomas in Europe: report from the RARECARE project. Eur J Cancer 2013; 49 (3): 684–95.  Back to cited text no. 2
    
3.
ESMO/European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25 Suppl 3: iii102–12.  Back to cited text no. 3
    
4.
Judson I, Verweij J, Gelderblom H, Hartmann JT, Schöffski P, Blay JY, Kerst JM, Sufliarsky J, Whelan J, Hohenberger P, Krarup-Hansen A, Alcindor T, Marreaud S, Litière S, Hermans C, Fisher C, Hogendoorn PC, dei Tos AP, van der Graaf WT; European Organisation and Treatment of Cancer Soft Tissue and Bone Sarcoma Group. Doxorubicin alone versus intensified doxorubicin plus ifosfamide for first-line treatment of advanced or metastatic soft-tissue sarcoma: a randomised controlled phase 3 trial. Lancet Oncol 2014; 15 (4): 415–23.  Back to cited text no. 4
    
5.
Italiano A, Mathoulin-Pelissier S, Cesne AL, Terrier P, Bonvalot S, Collin F, Michels JJ, Blay JY, Coindre JM, Bui B. Trends in survival for patients with metastatic soft-tissue sarcoma. Cancer 2011; 117 (5): 1049–54.  Back to cited text no. 5
    
6.
D'Incalci M, Galmarini CM. A review of trabectedin (ET-743): a unique mechanism of action. Mol Cancer Ther 2010; 9 (8): 2157–63.  Back to cited text no. 6
    
7.
Allavena P, Signorelli M, Chieppa M, Erba E, Bianchi G, Marchesi F, Olimpio CO, Bonardi C, Garbi A, Lissoni A, de Braud F, Jimeno J, D'Incalci M. Anti-inflammatory properties of the novel antitumor agent yondelis (trabectedin): inhibition of macrophage differentiation and cytokine production. Cancer Res 2005; 65 (7): 2964–71.  Back to cited text no. 7
    
8.
Germano G, Frapolli R, Belgiovine C, Anselmo A, Pesce S, Liguori M, Erba E, Uboldi S, Zucchetti M, Pasqualini F, Nebuloni M, van Rooijen N, Mortarini R, Beltrame L, Marchini S, Fuso Nerini I, Sanfilippo R, Casali PG, Pilotti S, Galmarini CM, Anichini A, Mantovani A, D'Incalci M, Allavena P. Role of macrophage targeting in the antitumor activity of trabectedin. Cancer Cell 2013; 23 (2): 249–62.  Back to cited text no. 8
    
9.
Yovine A, Riofrio M, Blay JY, Brain E, Alexandre J, Kahatt C, Taamma A, Jimeno J, Martin C, Salhi Y, Cvitkovic E, Misset JL. Phase II study of ecteinascidin-743 in advanced pretreated soft tissue sarcoma patients. J Clin Oncol 2004; 22 (5): 890–9.  Back to cited text no. 9
    
10.
Le Cesne A, Blay JY, Judson I, Van Oosterom A, Verweij J, Radford J, Lorigan P, Rodenhuis S, Ray-Coquard I, Bonvalot S, Collin F, Jimeno J, Di Paola E, Van Glabbeke M, Nielsen OS. Phase II study of ET-743 in advanced soft tissue sarcomas: a European Organisation for the Research and Treatment of Cancer (EORTC) soft tissue and bone sarcoma group trial. J Clin Oncol 2005; 23 (3): 576–84.  Back to cited text no. 10
    
11.
Demetri GD, Chawla SP, von Mehren M, Ritch P, Baker LH, Blay JY, Hande KR, Keohan ML, Samuels BL, Schuetze S, Lebedinsky C, Elsayed YA, Izquierdo MA, Gómez J, Park YC, Le Cesne A. Efficacy and safety of trabectedin in patients with advanced or metastatic liposarcoma or leiomyosarcoma after failure of prior anthracyclines and ifosfamide: results of a randomized phase II study of two different schedules. J Clin Oncol 2009; 27 (25): 4188–96.  Back to cited text no. 11
    
12.
Demetri GD, von Mehren M, Jones RL, Hensley ML, Schuetze SM, Staddon A, Milhem M, Elias A, Ganjoo K, Tawbi H, Van Tine BA, Spira A, Dean A, Khokhar NZ, Park YC, Knoblauch RE, Parekh TV, Maki RG, Patel SR. Efficacy and safety of trabectedin or dacarbazine for metastatic liposarcoma or leiomyosarcoma after failure of conventional chemotherapy: results of a phase III randomized multicenter clinical trial. J Clin Oncol 2016; 34 (8): 786–93.  Back to cited text no. 12
    
13.
Garcia-Carbonero R, Supko JG, Manola J, Seiden MV, Harmon D, Ryan DP, Quigley MT, Merriam P, Canniff J, Goss G, Matulonis U, Maki RG, Lopez T, Puchalski TA, Sancho MA, Gomez J, Guzman C, Jimeno J, Demetri GD. Phase II and pharmacokinetic study of ecteinascidin 743 in patients with progressive sarcomas of soft tissues refractory to chemotherapy. J Clin Oncol 2004; 22 (8): 1480–90.  Back to cited text no. 13
    
14.
Kawai A, Araki N, Sugiura H, Ueda T, Yonemoto T, Takahashi M, Morioka H, Hiraga H, Hiruma T, Kunisada T, Matsumine A, Tanase T, Hasegawa T, Takahashi S. Trabectedin monotherapy after standard chemotherapy versus best supportive care in patients with advanced, translocation-related sarcoma: a randomised, open-label, phase 2 study. Lancet Oncol 2015; 16 (4): 406–16.  Back to cited text no. 14
    
15.
Blay JY, Leahy MG, Nguyen BB, Patel SR, Hohenberger P, Santoro A, Staddon AP, Penel N, Piperno-Neumann S, Hendifar A, Lardelli P, Nieto A, Alfaro V, Chawla SP. Randomised phase III trial of trabectedin versus doxorubicin-based chemotherapy as first-line therapy in translocation-related sarcomas. Eur J Cancer 2014; 50 (6): 1137–47.  Back to cited text no. 15
    
16.
Van Glabbeke M, Verweij J, Judson I, Nielsen OS; EORTC Soft Tissue and Bone Sarcoma Group. Progression-free rate as the principal end-point for phase II trials in soft-tissue sarcomas. Eur J Cancer 2002; 38 (4): 543–9.  Back to cited text no. 16
    
17.
Grosso F, Dileo P, Sanfilippo R, Stacchiotti S, Bertulli R, Piovesan C, Jimeno J, D'Incalci M, Gescher A, Casali PG. Steroid premedication markedly reduces liver and bone marrow toxicity of trabectedin in advanced sarcoma. Eur J Cancer 2006; 42 (10): 1484–90.  Back to cited text no. 17
    
18.
Le Cesne A, Blay JY, Domont J, Tresch-Bruneel E, Chevreau C, Bertucci F, Delcambre C, Saada-Bouzid E, Piperno-Neumann S, Bay JO, Mir O, Ray-Coquard I, Ryckewaert T, Valentin T, Isambert N, Italiano A, Clisant S, Penel N. Interruption versus continuation of trabectedin in patients with soft-tissue sarcoma (T-DIS): a randomised phase 2 trial. Lancet Oncol 2015; 16 (3): 312–9.  Back to cited text no. 18
    
19.
Grosso F, Jones RL, Demetri GD, Judson IR, Blay JY, Le Cesne A, Sanfilippo R, Casieri P, Collini P, Dileo P, Spreafico C, Stacchiotti S, Tamborini E, Tercero JC, Jimeno J, D'Incalci M, Gronchi A, Fletcher JA, Pilotti S, Casali PG. Efficacy of trabectedin (ecteinascidin-743) in advanced pretreated myxoid liposarcomas: a retrospective study. Lancet Oncol 2007; 8 (7): 595–602.  Back to cited text no. 19
    
20.
Hurwitz HI, Dowlati A, Saini S, Savage S, Suttle AB, Gibson DM, Hodge JP, Merkle EM, Pandite L. Phase I trial of pazopanib in patients with advanced cancer. Clin Cancer Res 2009; 15 (12): 4220–7.  Back to cited text no. 20
    
21.
Sleijfer S, Ray-Coquard I, Papai Z, Le Cesne A, Scurr M, Schöffski P, Collin F, Pandite L, Marreaud S, De Brauwer A, van Glabbeke M, Verweij J, Blay JY. Pazopanib, a multikinase angiogenesis inhibitor, in patients with relapsed or refractory advanced soft tissue sarcoma: a phase II study from the European organisation for research and treatment of cancer-soft tissue and bone sarcoma group (EORTC study 62043). J Clin Oncol 2009; 27 (19): 3126–32.  Back to cited text no. 21
    
22.
van der Graaf WT, Blay JY, Chawla SP, Kim DW, Bui-Nguyen B, Casali PG, Schöffski P, Aglietta M, Staddon AP, Beppu Y, Le Cesne A, Gelderblom H, Judson IR, Araki N, Ouali M, Marreaud S, Hodge R, Dewji MR, Coens C, Demetri GD, Fletcher CD, Dei Tos AP, Hohenberger P; EORTC Soft Tissue and Bone Sarcoma Group; PALETTE study group. EORTC Soft Tissue and Bone Sarcoma Group. Pazopanib for metastatic soft-tissue sarcoma (PALETTE): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2012; 379 (9829): 1879–86.  Back to cited text no. 22
    
23.
Valverde C, Martin Broto J, Lopez-Martin JA, Romagosa C, Sancho Marquez P, Carrasco JA, Poveda A, Bauer S, Martinez-Trufero J, Cruz J Reichardt P, Luna Fra P, Gruenwald V, Persiva O, Varona Porres DK. Phase II clinical trial evaluating the activity and tolerability of pazopanib in patients (pts) with advanced and/or metastatic liposarcoma (LPS): a joint Spanish Sarcoma Group (GEIS) and German Interdisciplinary Sarcoma Group (GISG) Study-NCT01692496. Abstract presented at the 52th Annual Meeting of the American Society of Clinical Oncology. Chicago, IL; June 3–7, 2016. Abstract 11039.  Back to cited text no. 23
    
24.
Smith JA, Wilson L, Azarenko O, Zhu X, Lewis BM, Littlefield BA, Jordan MA. Eribulin binds at microtubule ends to a single site on tubulin to suppress dynamic instability. Biochemistry 2010; 49 (6): 1331–7.  Back to cited text no. 24
    
25.
Schöffski P, Ray-Coquard IL, Cioffi A, Bui NB, Bauer S, Hartmann JT, Krarup-Hansen A, Grünwald V, Sciot R, Dumez H, Blay JY, Le Cesne A, Wanders J, Hayward C, Marreaud S, Ouali M, Hohenberger P; European Organisation for Research and Treatment of Cancer (EORTC) Soft Tissue and Bone Sarcoma Group (STBSG). Activity of eribulin mesylate in patients with soft-tissue sarcoma: a phase 2 study in four independent histological subtypes. Lancet Oncol 2011; 12 (11): 1045–52.  Back to cited text no. 25
    
26.
Schöffski P, Maki RG, Italiano A, Gelderblom H, Grignani G, De Camargo VP, Bauer S, Rha SY, Chawla SP, Blay JY, Hohenberger P, D'Adamo DR, Wang B, Chmielowski BP. Randomized, open-label, multicenter, phase III study of eribulin versus dacarbazine in patients (pts) with leiomyosarcoma (LMS) and adipocytic sarcoma (ADI). Abstract presented at the 51th Annual Meeting of the American Society of Clinical Oncology. Chicago, IL; May 29 – June 2, 2015. Abstract 10502.  Back to cited text no. 26
    
27.
Silver Springs: U.S. Food and Drug Administration. Available from: http://www.fda.gov/.fda.gov [Internet]. [Last cited on 2016 Dec 08].  Back to cited text no. 27
    
28.
Ducoulombier A, Cousin S, Kotecki N, Penel N. Gemcitabine-based chemotherapy in sarcomas: a systematic review of published trials. Crit Rev Oncol Hematol 2016; 98: 73–80.  Back to cited text no. 28
    
29.
Patel SR, Gandhi V, Jenkins J, Papadopolous N, Burgess MA, Plager C, Plunkett W, Benjamin RS. Phase II clinical investigation of gemcitabine in advanced soft tissue sarcomas and window evaluation of dose rate on gemcitabine triphosphate accumulation. J Clin Oncol 2001; 19 (15): 3483–9.  Back to cited text no. 29
    
30.
Pautier P, Floquet A, Penel N, Piperno-Neumann S, Isambert N, Rey A, Bompas E, Cioffi A, Delcambre C, Cupissol D, Collin F, Blay JY, Jimenez M, Duffaud F. Randomized multicenter and stratified phase II study of gemcitabine alone versus gemcitabine and docetaxel in patients with metastatic or relapsed leiomyosarcomas: a Federation Nationale des Centres de Lutte Contre le Cancer (FNCLCC) French Sarcoma Group study (TAXOGEM study). Oncologist 2012; 17 (9): 1213–20.  Back to cited text no. 30
    
31.
Hensley ML, Blessing JA, Degeest K, Abulafia O, Rose PG, Homesley HD. Fixed-dose rate gemcitabine plus docetaxel as second-line therapy for metastatic uterine leiomyosarcoma: a Gynecologic Oncology Group phase II study. Gynecol Oncol 2008; 109 (3): 323–8.  Back to cited text no. 31
    
32.
Maki RG, Wathen JK, Patel SR, Priebat DA, Okuno SH, Samuels B, Fanucchi M, Harmon DC, Schuetze SM, Reinke D, Thall PF, Benjamin RS, Baker LH, Hensley ML. Randomized phase II study of gemcitabine and docetaxel compared with gemcitabine alone in patients with metastatic soft tissue sarcomas: results of sarcoma alliance for research through collaboration study 002. J Clin Oncol 2009; 25 (19): 2755–63.  Back to cited text no. 32
    
33.
Hensley ML, Blessing JA, Mannel R, Rose PG. Fixed-dose rate gemcitabine plus docetaxel as first-line therapy for metastatic uterine leiomyosarcoma: a Gynecologic Oncology Group phase II trial. Gynecol Oncol 2008; 109 (3): 329–34.  Back to cited text no. 33
    
34.
Losa R, Fra J, López-Pousa A, Sierra M, Goitia A, Uña E, Nadal R, Del Muro JG, Gión M, Maurel J, Escudero P, Esteban E, Buesa JM. Phase II study with the combination of gemcitabine and DTIC in patients with advanced soft tissue sarcomas. Cancer Chemother Pharmacol 2007; 59 (2): 251–9.  Back to cited text no. 34
    
35.
García-Del-Muro X, López-Pousa A, Maurel J, Martín J, Martínez-Trufero J, Casado A, Gómez-España A, Fra J, Cruz J, Poveda A, Meana A, Pericay C, Cubedo R, Rubió J, De Juan A, Laínez N, Carrasco JA, de Andrés R, Buesa JM; Spanish Group for Research on Sarcomas. Randomized phase II study comparing gemcitabine plus dacarbazine versus dacarbazine alone in patients with previously treated soft tissue sarcoma: a Spanish Group for Research on Sarcomas study. J Clin Oncol 2011; 29 (18): 2528–33.  Back to cited text no. 35
    
36.
Xie J, Yuan J, Lu L. Gemcitabine fixed-dose rate infusion for the treatment of pancreatic carcinoma: a meta-analysis of randomized controlled trials. Diagn Pathol 2014; 9: 214.  Back to cited text no. 36
    
37.
Ceribelli A, Gridelli C, De Marinis F, Fabi A, Gamucci T, Cortesi E, Barduagni M, Antimi M, Maione P, Migliorino MR, Giannarelli D, Cognetti F. Prolonged gemcitabine infusion in advanced non-small cell lung carcinoma: a randomized phase II study of two different schedules in combination with cisplatin. Cancer 2003; 98 (2): 337–43.  Back to cited text no. 37
    
38.
Seddon BM, Whelan J, Strauss SJ, Leahy MG, Woll PJ, Cowie F, Rothermundt CA, Wood Z, Forsyth S, Khan I, Nash S, Patterson PB. GeDDiS: a prospective randomised controlled phase III trial of gemcitabine and docetaxel compared with doxorubicin as first-line treatment in previously untreated advanced unresectable or metastatic soft tissue sarcomas (EudraCT 2009-014907-29). Abstract presented at the 51th Annual Meeting of the American Society of Clinical Oncology. Chicago, IL; May 29 – June 2, 2015. Abstract 10500.  Back to cited text no. 38
    
39.
Woll PJ, Judson I, Lee SM, Rodenhuis S, Nielsen OS, Buesa JM, Lorigan PC, Leyvraz S, Hermans C, van Glabbeke M, Verweij J. Temozolomide in adult patients with advanced soft tissue sarcoma: a phase II study of the EORTC Soft Tissue and Bone Sarcoma Group. Eur J Cancer 1999; 35 (3): 410–2.  Back to cited text no. 39
    
40.
Gottlieb JA, Benjamin RS, Baker LH, O'Bryan RM, Sinkovics JG, Hoogstraten B, Quagliana JM, Rivkin SE, Bodey GP Sr., Rodriguez V, Blumenschein GR, Saiki JH, Coltman C Jr., Burgess MA, Sullivan P, Thigpen T, Bottomley R, Balcerzak S, Moon TE. Role of DTIC (NSC-45388) in the chemotherapy of sarcomas. Cancer Treat Rep 1976; 60 (2): 199–203.  Back to cited text no. 40
    
41.
Garcia del Muro X, Lopez-Pousa A, Martin J, Buesa JM, Martinez-Trufero J, Casado A, Poveda A, Cruz J, Bover I, Maurel J; Spanish Group for Research on Sarcomas. A phase II trial of temozolomide as a 6-week, continuous, oral schedule in patients with advanced soft tissue sarcoma: a study by the Spanish Group for Research on Sarcomas. Cancer 2005; 104 (8): 1706–12.  Back to cited text no. 41
    
42.
Talbot SM, Keohan ML, Hesdorffer M, Orrico R, Bagiella E, Troxel AB, Taub RN. A phase II trial of temozolomide in patients with unresectable or metastatic soft tissue sarcoma. Cancer 2003; 98 (9): 1942–6.  Back to cited text no. 42
    
43.
Stacchiotti S, Tortoreto M, Bozzi F, Tamborini E, Morosi C, Messina A, Libertini M, Palassini E, Cominetti D, Negri T, Gronchi A, Pilotti S, Zaffaroni N, Casali PG. Dacarbazine in solitary fibrous tumor: a case series analysis and preclinical evidence vis-a-vis temozolomide and antiangiogenics. Clin Cancer Res 2013; 19 (18): 5192–201.  Back to cited text no. 43
    
44.
Park MS, Patel SR, Ludwig JA, Trent JC, Conrad CA, Lazar AJ, Wang WL, Boonsirikamchai P, Choi H, Wang X, Benjamin RS, Araujo DM. Activity of temozolomide and bevacizumab in the treatment of locally advanced, recurrent, and metastatic hemangiopericytoma and malignant solitary fibrous tumor. Cancer 2011; 117 (21): 4939–47.  Back to cited text no. 44
    
45.
Penel N, Bui BN, Bay JO, Cupissol D, Ray-Coquard I, Piperno-Neumann S, Kerbrat P, Fournier C, Taieb S, Jimenez M, Isambert N, Peyrade F, Chevreau C, Bompas E, Brain EG, Blay JY. Phase II trial of weekly paclitaxel for unresectable angiosarcoma: the ANGIOTAX Study. J Clin Oncol 2008; 26 (32): 5269–74.  Back to cited text no. 45
    
46.
Ray-Coquard IL, Domont J, Tresch-Bruneel E, Bompas E, Cassier PA, Mir O, Piperno-Neumann S, Italiano A, Chevreau C, Cupissol D, Bertucci F, Bay JO, Collard O, Saada-Bouzid E, Isambert N, Delcambre C, Clisant S, Le Cesne A, Blay JY, Penel N. Paclitaxel given once per week with or without bevacizumab in patients with advanced angiosarcoma: a randomized phase II trial. J Clin Oncol 2015; 33 (25): 2797–802.  Back to cited text no. 46
    
47.
Cianfrocca M, Lee S, Von Roenn J, Tulpule A, Dezube BJ, Aboulafia DM, Ambinder RF, Lee JY, Krown SE, Sparano JA. Randomized trial of paclitaxel versus pegylated liposomal doxorubicin for advanced human immunodeficiency virus-associated Kaposi sarcoma: evidence of symptom palliation from chemotherapy. Cancer 2011; 116 (16): 3969–77.  Back to cited text no. 47
    
48.
Benson C, Vitfell-Rasmussen J, Maruzzo M, Fisher C, Tunariu N, Mitchell S, Al-Muderis O, Thway K, Larkin J, Judson I. A retrospective study of patients with malignant PEComa receiving treatment with sirolimus or temsirolimus: the Royal Marsden Hospital experience. Anticancer Res 2014; 34 (7): 3663–8.  Back to cited text no. 48
    
49.
Wagner AJ, Malinowska-Kolodziej I, Morgan JA, Qin W, Fletcher CD, Vena N, Ligon AH, Antonescu CR, Ramaiya NH, Demetri GD, Kwiatkowski DJ, Maki RG. Clinical activity of mTOR inhibition with sirolimus in malignant perivascular epithelioid cell tumors: targeting the pathogenic activation of mTORC1 in tumors. J Clin Oncol 2010; 28 (5): 835–40.  Back to cited text no. 49
    
50.
Butrynski JE, D'Adamo DR, Hornick JL, Dal Cin P, Antonescu CR, Jhanwar SC, Ladanyi M, Capelletti M, Rodig SJ, Ramaiya N, Kwak EL, Clark JW, Wilner KD, Christensen JG, Jänne PA, Maki RG, Demetri GD, Shapiro GI. Crizotinib in ALK-rearranged inflammatory myofibroblastic tumor. N Engl J Med 2010; 363 (18): 1727–33.  Back to cited text no. 50
    
51.
Rutkowski P, Van Glabbeke M, Rankin CJ, Ruka W, Rubin BP, Debiec-Rychter M, Lazar A, Gelderblom H, Sciot R, Lopez-Terrada D, Hohenberger P, van Oosterom AT, Schuetze SM; European Organisation for Research and Treatment of Cancer Soft Tissue/Bone Sarcoma Group; Southwest Oncology Group. Imatinib mesylate in advanced dermatofibrosarcoma protuberans: pooled analysis of two phase II clinical trials. J Clin Oncol 2010; 28 (10): 1772–9.  Back to cited text no. 51
    
52.
Heinrich MC, Joensuu H, Demetri GD, Corless CL, Apperley J, Fletcher JA, Soulieres D, Dirnhofer S, Harlow A, Town A, McKinley A, Supple SG, Seymour J, Di Scala L, van Oosterom A, Herrmann R, Nikolova Z, McArthur AG; Imatinib Target Exploration Consortium Study B2225. Phase II, open-label study evaluating the activity of imatinib in treating life-threatening malignancies known to be associated with imatinib-sensitive tyrosine kinases. Clin Cancer Res 2008; 14 (9): 2717–25.  Back to cited text no. 52
    
53.
Ugurel S, Mentzel T, Utikal J, Helmbold P, Mohr P, Pföhler C, Schiller M, Hauschild A, Hein R, Kämpgen E, Kellner I, Leverkus M, Becker JC, Ströbel P, Schadendorf D. Neoadjuvant imatinib in advanced primary or locally recurrent dermatofibrosarcoma protuberans: a multicenter phase II DeCOG trial with long-term follow-up. Clin Cancer Res 2014; 20 (2): 499–510.  Back to cited text no. 53
    
54.
Stacchiotti S, Negri T, Zaffaroni N, Palassini E, Morosi C, Brich S, Conca E, Bozzi F, Cassinelli G, Gronchi A, Casali PG, Pilotti S. Sunitinib in advanced alveolar soft part sarcoma: evidence of a direct antitumor effect. Ann Oncol 2011; 22 (7): 1682–90.  Back to cited text no. 54
    
55.
Kummar S, Strassberger A, Monks A, Ivy SP, Turkbey IB, Choyke PL, Steinberg SM, Simon R, Doroshow JH, Helman LJ; Developmental Therapeutics Clinical Group, National Cancer Institute. An evaluation of cediranib as a new agent for alveolar soft part sarcoma (ASPS). Abstract presented at the 47th Annual Meeting of the American Society of Clinical Oncology. Chicago, IL; June 3–7, 2011. Abstract 10001.  Back to cited text no. 55
    
56.
Stacchiotti S, Pantaleo MA, Astolfi A, Dagrada GP, Negri T, Dei Tos AP, Indio V, Morosi C, Gronchi A, Colombo C, Conca E, Toffolatti L, Tazzari M, Crippa F, Maestro R, Pilotti S, Casali PG. Activity of sunitinib in extraskeletal myxoid chondrosarcoma. Eur J Cancer 2014; 50 (9): 1657–64.  Back to cited text no. 56
    
57.
Stacchiotti S, Negri T, Libertini M, Palassini E, Marrari A, De Troia B, Gronchi A, Dei Tos AP, Morosi C, Messina A, Pilotti S, Casali PG. Sunitinib malate in solitary fibrous tumor (SFT). Ann Oncol 2012; 23 (12): 3171–9.  Back to cited text no. 57
    
58.
Stacchiotti S, Tortoreto M, Baldi GG, Grignani G, Toss A, Badalamenti G, Cominetti D, Morosi C, Dei Tos AP, Festinese F, Fumagalli E, Provenzano S, Gronchi A, Pennacchioli E, Negri T, Dagrada GP, Spagnuolo RD, Pilotti S, Casali PG, Zaffaroni N. Preclinical and clinical evidence of activity of pazopanib in solitary fibrous tumour. Eur J Cancer 2014; 50 (17): 3021–8.  Back to cited text no. 58
    
59.
Movva S, Wen W, Chen W, Millis SZ, Gatalica Z, Reddy S, von Mehren M, Van Tine BA. Multi-platform profiling of over 2000 sarcomas: identification of biomarkers and novel therapeutic targets. Oncotarget 2015; 6 (14): 12234–47.  Back to cited text no. 59
    
60.
Ehnman M, Missiaglia E, Folestad E, Selfe J, Strell C, Thway K, Brodin B, Pietras K, Shipley J, Östman A, Eriksson U. Distinct effects of ligand-induced PDGFRα and PDGFRβ signaling in the human rhabdomyosarcoma tumor cell and stroma cell compartments. Cancer Res 2013; 73 (7): 2139–49.  Back to cited text no. 60
    
61.
Doi T, Ma Y, Dontabhaktuni A, Nippgen C, Nippgen J, Ohtsu A. Phase I study of olaratumab in Japanese patients with advanced solid tumors. Cancer Sci 2014; 105 (7): 862–9.  Back to cited text no. 61
    
62.
Chiorean EG, Sweeney C, Youssoufian H, Qin A, Dontabhaktuni A, Loizos N, Nippgen J, Amato R. A phase I study of olaratumab, an anti-platelet-derived growth factor receptor alpha (PDGFRα) monoclonal antibody, in patients with advanced solid tumors. Cancer Chemother Pharmacol 2014; 73 (3): 595–604.  Back to cited text no. 62
    
63.
Tap WD, Jones RL, Van Tine BA, Chmielowski B, Elias AD, Adkins D, Agulnik M, Cooney MM, Livingston MB, Pennock G, Hameed MR, Shah GD, Qin A, Shahir A, Cronier DM, Ilaria R Jr., Conti I, Cosaert J, Schwartz GK. Olaratumab and doxorubicin versus doxorubicin alone for treatment of soft-tissue sarcoma: an open-label phase 1b and randomised phase 2 trial. Lance t 2016; 388 (10043): 488–97.  Back to cited text no. 63
    
64.
ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). c2000. Available from: http://www.clinicaltrials.gov/show/NCT02451943. [Last cited 2016 Dec 08].  Back to cited text no. 64
    
65.
ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). c2000. Available from: http://www.clinicaltrials.gov/show/NCT02659020. [Last cited 2016 Dec 08].  Back to cited text no. 65
    
66.
Sabah M, Cummins R, Leader M, Kay E. Aberrant expression of the Rb pathway proteins in soft tissue sarcomas. Appl Immunohistochem Mol Morphol 2006; 14 (4): 397–403.  Back to cited text no. 66
    
67.
Finn RS, Crown JP, Lang I, Boer K, Bondarenko IM, Kulyk SO, Ettl J, Patel R, Pinter T, Schmidt M, Shparyk Y, Thummala AR, Voytko NL, Fowst C, Huang X, Kim ST, Randolph S, Slamon DJ. The cyclin-dependent kinase 4/6 inhibitor palbociclib in combination with letrozole versus letrozole alone as first-line treatment of oestrogen receptor-positive, HER2-negative, advanced breast cancer (PALOMA-1/TRIO-18): a randomised phase 2 study. Lancet Oncol 2015; 16 (1): 25–35.  Back to cited text no. 67
    
68.
Turner NC, Ro J, André F, Loi S, Verma S, Iwata H, Harbeck N, Loibl S, Huang Bartlett C, Zhang K, Giorgetti C, Randolph S, Koehler M, Cristofanilli M; PALOMA3 Study Group. Palbociclib in Hormone-Receptor-Positive Advanced Breast Cancer. N Engl J Med 2015; 373 (3): 209–19.  Back to cited text no. 68
    
69.
Dickson MA, Tap WD, Keohan ML, D'Angelo SP, Gounder MM, Antonescu CR, Landa J, Qin LX, Rathbone DD, Condy MM, Ustoyev Y, Crago AM, Singer S, Schwartz GK. Phase II trial of the CDK4 inhibitor PD0332991 in patients with advanced CDK4-amplified well-differentiated or dedifferentiated liposarcoma. J Clin Oncol 2013; 31 (16): 2024–8.  Back to cited text no. 69
    
70.
Perez M, Muñoz-Galván S, Jiménez-García MP, Marín JJ, Carnero A. Efficacy of CDK4 inhibition against sarcomas depends on their levels of CDK4 and p16ink4 mRNA. Oncotarget 2015; 6 (38): 40557–74.  Back to cited text no. 70
    
71.
Parikh K, Cang S, Sekhri A, Liu D. Selective inhibitors of nuclear export (SINE) – A novel class of anti-cancer agents. J Hematol Oncol 2014; 7: 78.  Back to cited text no. 71
    
72.
Nakayama R, Zhang YX, Czaplinski JT, Anatone AJ, Sicinska ET, Fletcher JA, Demetri GD, Wagner AJ. Preclinical activity of selinexor, an inhibitor of XPO1, in sarcoma. Oncotarget 2016; 7 (13): 16581–92.  Back to cited text no. 72
    
73.
Gounder MM, Zer A, Tap WD, Salah S, Dickson MA, Gupta AA, Keohan ML, Loong HH, D'Angelo SP, Baker S, Condy M, Nyquist-Schultz K, Tanner L, Erinjeri JP, Jasmine FH, Friedlander S, Carlson R, Unger TJ, Saint-Martin JR, Rashal T, Ellis J, Kauffman M, Shacham S, Schwartz GK, Abdul Razak AR. Phase IB study of selinexor, a first-in-class inhibitor of nuclear export, in patients with advanced refractory bone or soft tissue sarcoma. J Clin Oncol 2016; 34 (26): 3166–74.  Back to cited text no. 73
    
74.
Kager L, Pötschger U, Bielack S. Review of mifamurtide in the treatment of patients with osteosarcoma. Ther Clin Risk Manag 2010; 6: 279–86.  Back to cited text no. 74
    
75.
Tazzari M, Negri T, Rini F, Vergani B, Huber V, Villa A, Dagrada P, Colombo C, Fiore M, Gronchi A, Stacchiotti S, Casali PG, Pilotti S, Rivoltini L, Castelli C. Adaptive immune contexture at the tumour site and downmodulation of circulating myeloid-derived suppressor cells in the response of solitary fibrous tumour patients to anti-angiogenic therapy. Br J Cancer 2014; 111 (7): 1350–62.  Back to cited text no. 75
    
76.
Apetoh L, Ghiringhelli F, Tesniere A, Obeid M, Ortiz C, Criollo A, Mignot G, Maiuri MC, Ullrich E, Saulnier P, Yang H, Amigorena S, Ryffel B, Barrat FJ, Saftig P, Levi F, Lidereau R, Nogues C, Mira JP, Chompret A, Joulin V, Clavel-Chapelon F, Bourhis J, André F, Delaloge S, Tursz T, Kroemer G, Zitvogel L. Toll-like receptor 4-dependent contribution of the immune system to anticancer chemotherapy and radiotherapy. Nat Med 2007; 13 (9): 1050–9.  Back to cited text no. 76
    
77.
Obeid M, Tesniere A, Ghiringhelli F, Fimia GM, Apetoh L, Perfettini JL, Castedo M, Mignot G, Panaretakis T, Casares N, Métivier D, Larochette N, van Endert P, Ciccosanti F, Piacentini M, Zitvogel L, Kroemer G. Calreticulin exposure dictates the immunogenicity of cancer cell death. Nat Med 2007; 13 (1): 54–61.  Back to cited text no. 77
    
78.
Hussner J, Ameling S, Hammer E, Herzog S, Steil L, Schwebe M, Niessen J, Schroeder HW, Kroemer HK, Ritter CA, Völker U, Bien S. Regulation of interferon-inducible proteins by doxorubicin via interferon γ-Janus tyrosine kinase-signal transducer and activator of transcription signaling in tumor cells. Mol Pharmacol 2012; 81 (5): 679–88.  Back to cited text no. 78
    
79.
Mu CY, Huang JA, Chen Y, Chen C, Zhang XG. High expression of PD-L1 in lung cancer may contribute to poor prognosis and tumor cells immune escape through suppressing tumor infiltrating dendritic cells maturation. Med Oncol 2011; 28 (3): 682–8.  Back to cited text no. 79
    
80.
Nakanishi J, Wada Y, Matsumoto K, Azuma M, Kikuchi K, Ueda S. Overexpression of B7-H1 (PD-L1) significantly associates with tumor grade and postoperative prognosis in human urothelial cancers. Cancer Immunol Immunother 2007; 56 (8): 1173–82.  Back to cited text no. 80
    
81.
Garon EB, Rizvi NA, Hui R, Leighl N, Balmanoukian AS, Eder JP, Patnaik A, Aggarwal C, Gubens M, Horn L, Carcereny E, Ahn MJ, Felip E, Lee JS, Hellmann MD, Hamid O, Goldman JW, Soria JC, Dolled-Filhart M, Rutledge RZ, Zhang J, Lunceford JK, Rangwala R, Lubiniecki GM, Roach C, Emancipator K, Gandhi L; KEYNOTE-001 Investigators. Pembrolizumab for the treatment of non-small-cell lung cancer. N Engl J Med 2015; 372 (21): 2018–28.  Back to cited text no. 81
    
82.
Rosenberg JE, Hoffman-Censits J, Powles T, van der Heijden MS, Balar AV, Necchi A, Dawson N, O'Donnell PH, Balmanoukian A, Loriot Y, Srinivas S, Retz MM, Grivas P, Joseph RW, Galsky MD, Fleming MT, Petrylak DP, Perez-Gracia JL, Burris HA, Castellano D, Canil C, Bellmunt J, Bajorin D, Nickles D, Bourgon R, Frampton GM, Cui N, Mariathasan S, Abidoye O, Fine GD, Dreicer R. Atezolizumab in patients with locally advanced and metastatic urothelial carcinoma who have progressed following treatment with platinum-based chemotherapy: a single-arm, multicentre, phase 2 trial. Lancet 2016; 387 (10031): 1909–20.  Back to cited text no. 82
    
83.
D'Angelo SP, Shoushtari AN, Agaram NP, Kuk D, Qin LX, Carvajal RD, Dickson MA, Gounder M, Keohan ML, Schwartz GK, Tap WD. Prevalence of tumor-infiltrating lymphocytes and PD-L1 expression in the soft tissue sarcoma microenvironment. Hum Pathol 2015; 46 (3): 357–65.  Back to cited text no. 83
    
84.
Kim JR, Moon YJ, Kwon KS, Bae JS, Wagle S, Kim KM, Park HS, Lee H, Moon WS, Chung MJ, Kang MJ, Jang KY. T Tumor infiltrating PD1-positive lymphocytes and the expression of PD-L1 predict poor prognosis of soft tissue sarcomas. PLoS One 2013; 8 (12): e82870.  Back to cited text no. 84
    
85.
Kim C, Kim EK, Jung H, Chon HJ, Han JW, Shin KH, Hu H, Kim KS, Choi YD, Kim S, Lee YH, Suh JS, Ahn JB, Chung HC, Noh SH, Rha SY, Kim SH, Kim HS. Prognostic implications of PD-L1 expression in patients with soft tissue sarcoma. BMC Cancer 2016; 16: 434.  Back to cited text no. 85
    
86.
Tawbi H, Burgess MA, Crowley J, Van Tine BA, Hu J, Schuetze S, D'Angelo SP, Attia S, Priebat DA, Okuno SH, Riedel RF, Davis LE, Movva S, Reed DR, Baker LH, Reinke DK, Maki RG, Patel S. Safety and efficacy of PD-1 blockade using pembrolizumab in patients with advanced soft tissue (STS) and bone sarcomas (BS): results of SARC028 – A multicenter phase II study. Abstract presented at the 52th Annual Meeting of the American Society of Clinical Oncology. Chicago, IL; June 3–7, 2016. Abstract 11006.  Back to cited text no. 86
    
87.
Veit JA, Heine D, Thierauf J, Lennerz J, Shetty S, Schuler PJ, Whiteside T, Beutner D, Meyer M, Grünewald I, Ritter G, Gnjatic S, Sikora AG, Hoffmann TK, Laban S. Expression and clinical significance of MAGE and NY-ESO-1 cancer-testis antigens in adenoid cystic carcinoma of the head and neck. Head Neck 2016; 38 (7): 1008–16.  Back to cited text no. 87
    
88.
Esfandiary A, Ghafouri-Fard S. New York esophageal squamous cell carcinoma-1 and cancer immunotherapy. Immunotherapy 2015; 7 (4): 411–39.  Back to cited text no. 88
    
89.
Shurell E, Vergara-Lluri ME, Li Y, Joe C, Singh A, Bernthal N, Wu H, Eilber FC, Dry SM. Comprehensive adipocytic and neurogenic tissue microarray analysis of NY-ESO-1 expression – A promising immunotherapy target in malignant peripheral nerve sheath tumor and liposarcoma. Oncotarget 2016; 7 (45): 72860–7.  Back to cited text no. 89
    
90.
Endo M, de Graaff MA, Ingram DR, Lim S, Lev DC, Briaire-de Bruijn IH, Somaiah N, Bovée JV, Lazar AJ, Nielsen TO. NY-ESO-1 (CTAG1B) expression in mesenchymal tumors. Mod Pathol 2014; 28 (4): 587–95.  Back to cited text no. 90
    
91.
Robbins PF, Kassim SH, Tran TL, Crystal JS, Morgan RA, Feldman SA, Yang JC, Dudley ME, Wunderlich JR, Sherry RM, Kammula US, Hughes MS, Restifo NP, Raffeld M, Lee CC, Li YF, El-Gamil M, Rosenberg SA. A pilot trial using lymphocytes genetically engineered with an NY-ESO-1-reactive T-cell receptor: long-term follow-up and correlates with response. Clin Cancer Res 2015; 21 (5): 1019–27.  Back to cited text no. 91
    



 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Current Systemic...
Other Cytotoxic ...
Upcoming Drugs
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed619    
    Printed5    
    Emailed0    
    PDF Downloaded133    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]