Chemotherapy for soft tissue sarcoma

Abstract

Purpose of review: After reading this article, the reader should understand the evolution of chemotherapy treatment of soft tissue sarcomas, acknowledge the limited efficacy of established chemotherapeutic regimens, and recognize the potential utility of targeted therapies. Recent findings: Relative success in the treatment of gastrointestinal stromal tumors utilizing imatinib mesylate, a selective inhibitor of certain tyrosine kinases, has heralded the development of new oncogene targeted drug therapies. Examples of target proteins include epidermal growth factor receptor/human epidermal growth factor receptor 2, insulin-like growth factor receptor (IGF-1R), fibroblast growth factor receptor1 (FGF1), and vascular endothelium growth factor (VEGF) among others. Summary: Despite excellent regional control of soft tissue sarcoma, a large number of patients (50%) die from metastatic disease. Considering the success of chemotherapy in the treatment of osteosarcoma, systemic chemotherapy for the treatment of soft tissue sarcoma seemed like a natural progression. A review of multiple trials performed since 1997, however, suggests that the efficacy of established chemotherapy regimens is poor. In fact, statistically significant differences at early time points become insignificant at later time points. To date, a critical understanding of the molecular fingerprint of soft tissue sarcoma is missing, knowledge of which will be required both for adequate classification of histologic variants and identification of tumor specific therapy targets.