Making the best of available options for optimal sarcoma treatment

For 35 years options for treating advanced soft tissue sarcoma (STS) were limited to doxorubicin, dacarbazine and ifosfamide. In 2007, trabectedin was approved. Since then, several other agents have become available and many more are in development, ushering in a new era in disease management. Considerable scope exists for improving outcomes of advanced STS through better trial design and improved patient care in everyday practice. After anthracycline failure, there are a range of treatment options and, increasingly, the choice of therapy is histology driven. Introduction of newer agents and optimising use of established agents such as trabectedin has led to an increase in overall survival of advanced STS patients. Optimising treatment with trabectedin is being achieved through more extensive experience in drug management, mainly associated with use in earlier lines and uninterrupted use until disease progression. Identification by next-generation sequencing of a significant proportion of cases of actionable mutations among patients with advanced STS suggests a move towards matched therapy in future. As the armamentarium of active agents in advanced sarcoma increases, so too will the challenge of selecting the right drug for the right patient at the right time, in accordance with the patient's lifestyle and wishes.