Doxorubicin‐Based Chemotherapy for the Palliative Treatment of AdultPatients with Locally Advanced or Metastatic Soft‐Tissue Sarcoma:A Meta‐Analysis and Clinical Practice Guideline

Abstract

Purpose. To make recommendations for the use of doxorubicin-based chemotherapy in patients with soft-tissue sarcoma.Patients. The recommendations apply to patients with symptomatic unresectable locally advanced or metastatic soft-tissue sarcoma who are candidates for palliative chemotherapy.Methods. A systematic review of the published literature was combined with a consensus process around the interpretation of the evidence in the context of conventional practice to develop an evidence-based practice guideline.Results. Eight randomized trials comparing doxorubicin-based combination versus doxorubicin single-agent chemotherapy were reviewed. Response rates and overall survival were evaluated using pooled statistical analysis.The pooled response data in 2281 patients showed a slight trend favouring the combination therapy, although this did not reach statistical significance (odds ratio (OR), 0.79; 95% confidence interval (CI), 0.60-1.05; p=0.10). Survival data could only be abstracted from six studies involving 2097 patients, and showed no significant advantage for combination therapy (OR, 0.84; 95% CI, 0.67-1.06; p=0.13). Data on adverse effects could not be combined in a meta-analysis; however nausea, vomiting and myelosuppression were consistently more severe with combination chemotherapy than with single-agent chemotherapy.Discussion. Single-agent doxorubicin is an appropriate first-line chemotherapy option for advanced or metastatic soft-tissue sarcoma. Some doxorubicin-based combination chemotherapy regimens, given in conventional doses, produce only marginal increases in response rates, at the expense of increased adverse effects, and with no improvements in overall survival. Future randomized clinical trials should compare new regimens, whose activity has been established in single-arm studies, with single-agent doxorubicin, and include quality of life as an outcome measure.

Primary and secondary angiosarcoma of the breast: The Mayo Clinic experience

“…In general, the chemotherapeutic regimen for soft tissue sarcomas is doxorubicin-based and response rates are typically 25-35% with overall survival times of 12 months [61][62][63]. Additionally, no survival benefit has been shown with combination drugs versus single agent doxorubicin [61,62]. However, for AS, particularly of the scalp and face, retrospective studies and phase II trials have shown striking results, even complete responses, with paclitaxel [64][65][66].…”

“…For patients with ASB, increased survival ultimately depends on the discovery and creation of new chemotherapeutics. In general, the chemotherapeutic regimen for soft tissue sarcomas is doxorubicin-based and response rates are typically 25-35% with overall survival times of 12 months [61][62][63]. Additionally, no survival benefit has been shown with combination drugs versus single agent doxorubicin [61,62].…”

Primary Breast Sarcoma: A rare pathology in women from the National Cancer Institute (INCan) of Mexico

“…The international consensus is that mastectomy can still be considered the gold standard. Surgical excision to clear margins is the procedure of choice, while the dissection of axillaries is not always indicated given the rareness of lymph node involvement [16][17][18][19][20][21]. Unfortunately, the role of adjuvant chemotherapy remains uncertain in the scientific literature [22,23], while the role and the timing of radiation and chemotherapy (pre-surgical vs. postsurgical) has varied [24][25][26].…”

Metastatic Secondary Fibrosarcoma of Bone Responsive to RepeatedCourses of Ifosfamide and Associated With Hypoglycemia

“…Many combinations show an improvement in response rate at the expense of significantly increased toxicity without an increase in overall survival. [12][13][14] It is unknown whether fibrosarcomas originating in bone are more responsive to regimens active in bone sarcomas (osteosarcoma or MFH-B) or STS. Because of this uncertainty we chose to treat our patient with consecutive single agents (doxorubicin and ifosfamide) that have documented activity in both bone and soft tissue sarcomas.…”