TY - JOUR
T1 - Patterns of care and outcomes of patients with METAstatic soft tissue SARComa in a real-life setting
T2 - The METASARC observational study
AU - Savina, Marion
AU - Le Cesne, Axel
AU - Blay, Jean Yves
AU - Ray-Coquard, Isabelle
AU - Mir, Olivier
AU - Toulmonde, Maud
AU - Cousin, Sophie
AU - Terrier, Philippe
AU - Ranchere-Vince, Dominique
AU - Meeus, Pierre
AU - Stoeckle, Eberhard
AU - Honoré, Charles
AU - Sargos, Paul
AU - Sunyach, Marie Pierre
AU - Le Péchoux, Cécile
AU - Giraud, Antoine
AU - Bellera, Carine
AU - Le Loarer, François
AU - Italiano, Antoine
N1 - Publisher Copyright:
© 2017 The Author(s).
PY - 2017/4/10
Y1 - 2017/4/10
N2 - Background: Well-designed observational studies of individuals with rare tumors are needed to improve patient care, clinical investigations, and the education of healthcare professionals. Methods: The patterns of care, outcomes, and prognostic factors of a cohort of 2225 patients with metastatic soft tissue sarcomas who were diagnosed between 1990 and 2013 and documented in the prospectively maintained database of the French Sarcoma Group were analyzed. Results: The median number of systemic treatments was 3 (range, 1-6); 27% of the patients did not receive any systemic treatment and 1054 (49%) patients underwent locoregional treatment of the metastasis. Half of the patients who underwent chemotherapy (n=810) received an off-label drug. Leiomyosarcoma was associated with a significantly better outcome than the other histological subtypes. With the exception of leiomyosarcomas, the benefit of a greater than third-line regimen was very limited, with a median time to next treatment (TNT) and overall survival (OS) ranging between 2.3 and 3.7months and 5.4 and 8.5months, respectively. The TNT was highly correlated with OS. Female sex, leiomyosarcoma histology, locoregional treatment of metastases, inclusion in a clinical trial, and treatment with first-line polychemotherapy were significantly associated with improved OS in the multivariate analysis. Conclusions: The combination of doxorubicin with a second drug, such as ifosfamide, represents a valid option, particularly when tumor shrinkage is expected to provide clinical benefits. After failure of the second-line therapy, best supportive care should be considered, particularly in patients with non-leiomyosarcoma histology who are not eligible to participate in a clinical trial. Locoregional treatment of metastasis should always be included in the therapeutic strategy when feasible. TNT may represent a useful surrogate endpoint for OS in clinical studies.
AB - Background: Well-designed observational studies of individuals with rare tumors are needed to improve patient care, clinical investigations, and the education of healthcare professionals. Methods: The patterns of care, outcomes, and prognostic factors of a cohort of 2225 patients with metastatic soft tissue sarcomas who were diagnosed between 1990 and 2013 and documented in the prospectively maintained database of the French Sarcoma Group were analyzed. Results: The median number of systemic treatments was 3 (range, 1-6); 27% of the patients did not receive any systemic treatment and 1054 (49%) patients underwent locoregional treatment of the metastasis. Half of the patients who underwent chemotherapy (n=810) received an off-label drug. Leiomyosarcoma was associated with a significantly better outcome than the other histological subtypes. With the exception of leiomyosarcomas, the benefit of a greater than third-line regimen was very limited, with a median time to next treatment (TNT) and overall survival (OS) ranging between 2.3 and 3.7months and 5.4 and 8.5months, respectively. The TNT was highly correlated with OS. Female sex, leiomyosarcoma histology, locoregional treatment of metastases, inclusion in a clinical trial, and treatment with first-line polychemotherapy were significantly associated with improved OS in the multivariate analysis. Conclusions: The combination of doxorubicin with a second drug, such as ifosfamide, represents a valid option, particularly when tumor shrinkage is expected to provide clinical benefits. After failure of the second-line therapy, best supportive care should be considered, particularly in patients with non-leiomyosarcoma histology who are not eligible to participate in a clinical trial. Locoregional treatment of metastasis should always be included in the therapeutic strategy when feasible. TNT may represent a useful surrogate endpoint for OS in clinical studies.
KW - Chemotherapy
KW - Metastases
KW - Outcome
KW - Patterns of care
KW - Sarcoma
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85018481363&partnerID=8YFLogxK
U2 - 10.1186/s12916-017-0831-7
DO - 10.1186/s12916-017-0831-7
M3 - Article
C2 - 28391775
AN - SCOPUS:85018481363
SN - 1741-7015
VL - 15
JO - BMC Medicine
JF - BMC Medicine
IS - 1
M1 - 78
ER -