Abstract
BackgroundConventional cytotoxic agents and pazopanib are approved for advanced soft tissue sarcomas but have low response rates and modest survival benefits. Recently, immune checkpoint inhibitors have shown clinically meaningful activity. The combination of pazopanib and immunotherapy has shown synergism in various other malignancies but has not been fully explored in advanced soft tissue sarcomas.Case presentationA 63 year old woman with metastatic undifferentiated pleomorphic sarcoma progressed after two lines of palliative combination chemotherapy—doxorubicin with olaratumab, and gemcitabine with docetaxel. In view of significant symptoms, she was treated with pazopanib in combination with pembrolizumab. She had remarkable radiological and clinical improvement, with a manageable toxicity profile and an ongoing response at ten months of therapy.ConclusionsUndifferentiated pleomorphic sarcoma is an immunologically active subtype of soft tissue sarcoma, which is particularly amenable to immune checkpoint inhibitors. Pazopanib with immune checkpoint inhibitors is a well-tolerated, yet hitherto underexplored combination that may offer significant clinical benefit in advanced sarcomas—this finding warrants further evaluation in clinical trials.
Highlights
Conventional cytotoxic agents and pazopanib are approved for advanced soft tissue sarcomas but have low response rates and modest survival benefits
Undifferentiated pleomorphic sarcoma is an immunologically active subtype of soft tissue sarcoma, which is amenable to immune checkpoint inhibitors
Phase 2 trial, Vascular endothelial growth factor (VEGF) Tyrosine kinase inhibitor (TKI) axitinib plus pembrolizumab was studied in 33 patients with advanced sarcoma who had progressed after or declined standard chemotherapy or targeted therapy [11]
Summary
Undifferentiated pleomorphic sarcoma is an immunologically active subtype of soft tissue sarcoma, which is amenable to immune checkpoint inhibitors.
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