Abstract
BackgroundMetastasized soft-tissue sarcomas still pose a significant therapeutic challenge given the limited efficacy of currently available multimodal treatment strategies. Recent progress in molecular characterization of sarcoma subtypes has enabled successful personalized therapy approaches in a minority of selected patients with targetable mutations. However, in the majority of patients with refractory soft tissue sarcomas, long-term survival remains poor.MethodsWe report on three adult patients with various soft tissue sarcomas subjected to Gemcitabine maintenance therapy. Tumor entities included leiomyosarcoma of the pancreas (patient 1), undifferentiated pleomorphic sarcoma of the right femur (patient 2), and peri-aortic leiomyosarcoma (patient 3). Metastatic sites encompassed liver, lung, and bones. All patients received Gemcitabine maintenance therapy until disease progression following prior salvage chemotherapy with Docetaxel and Gemcitabine. Patients were treated outside of clinical trials. Response assessment was based on radiological imaging.ResultsIn response to salvage chemotherapy with Docetaxel and Gemcitabine, one patient exhibited a partial remission, and two patients showed stable disease. Patient 1 exhibited stable disease for 6 months during Gemcitabine maintenance therapy before suffering rapid progression of hepatic metastases. Patient 2 underwent 21 months of Gemcitabine maintenance therapy, which was discontinued after progressive pulmonary metastases were detected. Patient 3 is still being treated with Gemcitabine maintenance therapy. Remarkably, owing to significant chemotherapy-associated hematotoxicity, the dose of Gemcitabine dose was reduced by two-thirds. Nevertheless, stable disease with constant pulmonary metastases has been maintained in this patient for 14 months.ConclusionsGemcitabine maintenance therapy following prior Docetaxel and Gemcitabine chemotherapy is manageable and reveals potential benefits for patients with aggressive metastasized soft tissue sarcomas. Prospective trials evaluating Gemcitabine maintenance therapy are encouraged.
Highlights
Metastasized soft-tissue sarcomas still pose a significant therapeutic challenge given the limited efficacy of currently available multimodal treatment strategies
Sarcoma diagnosis was confirmed in all three patients by histological examination [hematoxylin and eosin (H&E) staining and immunohistochemistry] and molecular analysis of biopsies obtained via excision or imaging-guided puncture
Tumor response was assessed by computed tomography (CT), magnetic resonance imaging (MRI), and F-18-fluorodeoxyglucose–positron emission tomography (PET)/computed tomography (CT)
Summary
Metastasized soft-tissue sarcomas still pose a significant therapeutic challenge given the limited efficacy of currently available multimodal treatment strategies. Recent progress in molecular characterization of sarcoma subtypes has enabled successful personalized therapy approaches in a minority of selected patients with targetable mutations. In the majority of patients with refractory soft tissue sarcomas, long-term survival remains poor. Despite multiple new anticancer agents available, the long-term survival of patients with advanced sarcomas remains dismal [1, 2]. While the majority of STS is located in the extremities, they can arise from virtually any site of the body [3]. Distant metastases are associated with a bad prognosis reflected by 5-year survival rates of about 15%, whereas patients with local STS exhibit 5-year survival of approximately 80% [2]. The paramount prognostic factors are the histological subtype, tumor–node–metastasis (TNM) stage, and surgical resection margins [2]
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