Poor treatment outcomes with palliative gemcitabine and docetaxel chemotherapy in advanced and metastatic synovial sarcoma

Alexandra Pender,Winette Van Der Graaf,Charlotte Benson,Christina Messiou,Shane Zaidi,Vicki L Keedy,Robin L Jones,Aisha Miah,Elizabeth J Davis,Khin Thway,Cyril Fisher,Ian Judson,Omar Al-Muderis,Dharmisha Chauhan

doi:10.1007/s12032-018-1193-5

Abstract

The outcome for patients with unresectable or metastatic soft tissue sarcoma remains poor with few treatment options. Synovial sarcoma is a rare type of sarcoma, predominantly affecting adolescents and young adults. Following failure of first-line anthracycline-based chemotherapy, several salvage options are available. We reviewed the safety and efficacy of gemcitabine/docetaxel chemotherapy in two tertiary oncology centres. We identified patients treated with gemcitabine/docetaxel between 2004 and 2016 in a UK and a US oncology centre using retrospective pharmacy and medical records. Treatment response, toxicity and outcome data were collected. Twenty one patients were treated with gemcitabine/docetaxel, the majority as a second- or third-line treatment for metastatic disease. The response rate was 5% with a median progression-free survival of 2 months (95% CI 1.3–3.7). Toxicities reported were as expected for this chemotherapy combination. Treatment was not discontinued due to toxicity. Gemcitabine/docetaxel chemotherapy shows little efficacy in synovial sarcoma and should not be offered to this patient group outside a clinical trial context.

Highlights

Soft tissue sarcomas are a heterogeneous group of rare tumours of mesenchymal origin
Gemcitabine and docetaxel combination chemotherapy has emerged as an effective salvage schedule in advanced sarcoma [3, 4, 16], leiomyosarcoma and undifferentiated pleomorphic sarcoma
Our results suggest that gemcitabine/docetaxel has little efficacy with a response rate of 5% and median PFS of 2 months

Summary

Introduction

Soft tissue sarcomas are a heterogeneous group of rare tumours of mesenchymal origin. They account for about 1% of adult cancers and 15% of paediatric tumours. The mainstay of management for localized disease is complete surgical resection with or without (neo)adjuvant radiation. Approximately 50% of patients with high-grade tumours will develop recurrent or metastatic disease. The outcome of patients with metastatic soft tissue sarcoma is poor with a median overall survival of 12–18 months. First-line chemotherapy for metastatic disease consists of an anthracycline-based regimen [1, 2].

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