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Part of the book series: Cancer Treatment and Research ((CTAR,volume 91))

Abstract

Once soft tissue sarcomas have become metastatic, or if local disease is too extensive for control with surgery and/or radiotherapy, chemotherapy may be considered as a possible treatment modality. Unfortunately adult soft tissue sarcomas are among the most chemoresistant of all malignancies, and it is important to know the limitations of its use as well as its potential value. This chapter summarizes our current knowledge of the activity of single-agent chemotherapy and of combination regimens, and reviews the potential value of high-dose and dose-intensive regimens. Given the limited value of conventional chemotherapy in this disease, future directions for research are discussed and the importance of treating patients within controlled clinical trials is emphasized.

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References

  1. O’Bryan RM, Luce JK, Talley RW, et al. Phase II evaluation of Adriamycin in human neoplasia. Cancer 32:1–8, 1973.

    Article  PubMed  Google Scholar 

  2. Verweij J, van Oosterom AT, Somers R, et al. Chemotherapy in the multidisciplinary approach to soft tissue sarcomas. Ann Oncol 3;S75–S80, 1992.

    PubMed  Google Scholar 

  3. O’Bryan RM, Baker LH, Gottlieb JE, et al. Dose response evaluation of Adriamycin in human neoplasia. Cancer 39:1940–1948, 1977.

    Article  PubMed  Google Scholar 

  4. Schoenfeld D, Rosenbaum C, Horton J, et al. A comparison of Adriamycin versus vincristine and Adriamycin and cyclophosphamide for advanced sarcoma. Cancer 50:2757–2762, 1982.

    Article  PubMed  CAS  Google Scholar 

  5. Pinedo HM, Bramwell VHC, Mouridsen VHC, et al. CyVADIC in advanced soft tissue sarcoma — a randomised study comparing two schedules. Cancer 53:1825–1832, 1984.

    Article  PubMed  CAS  Google Scholar 

  6. Bodey GP, Rodriguez V, Murphy WK, Burgess A, Benjamin RS. Protected environmentprophylactic antibiotic program for malignant sarcoma: Randomised trial during remission induction chemotherapy. Cancer 47:2422–2429, 1981.

    Article  PubMed  CAS  Google Scholar 

  7. Toma S, Palumbo R, Sogno G, Venturino A, Santi L. Doxorubicin (or epidoxorubicin) combined with ifosfamide in the treatment of adult advanced soft tissue sarcomas. Ann Oncol 3:S119–S123, 1992.

    PubMed  Google Scholar 

  8. Perevodchikova NI, Lichinister MR, Gorbunova VA, et al. Phase II clinical study of carminomycin: Its activity against soft tissue sarcomas. Cancer Treat Rep 61:1705–1707, 1977.

    PubMed  CAS  Google Scholar 

  9. Bramwell VHC, Mouridsen HT, Mulder JH, et al. Carminomycin versus Adriamycin in advanced soft tissue sarcoma. An EORTC randomised Phase II study. Eur J Cancer 19:1097–1104, 1983.

    Article  CAS  Google Scholar 

  10. Mouridsen HT, Bastholt L, Somers R, et al. Adriamycin versus epirubicin in advanced soft tissue sarcomas: A randomised phase II/phase III study of the EORTC Soft Tissue and Bone Sarcoma Group. Eur J Cancer Clin Oncol 23:1477–1483, 1987.

    Article  PubMed  CAS  Google Scholar 

  11. Chevalier B, Monteuquet PH, Fachini T, et al. Phase II study of epirubicin in advanced soft tissue sarcomas. Proc Am Soc Clin Oncol 8:323, 1989.

    Google Scholar 

  12. Dombernowsky P, Mouridsen H, Nielsen OS, et al. A phase III study comparing Adriamycin versus two schedules of high dose epirubicin in advanced soft tissue sarcoma. Proc Am Soc Clin Oncol 14:515, 1995.

    Google Scholar 

  13. Yang JC, Rosenberg SA, Glatstein EJ, Antman KH. Sarcomas of soft tissues. In VT De Vita, Jr., S Hellman, SA Rosenberg, eds. Cancer Principles and Practice of Oncology, 4th ed. Philadelphia: J.B. Lippincott, 199:1436–1488, 1993.

    Google Scholar 

  14. Hoefer-Janker H, Scheef W, Gunther U, Huls W. Erfahungen mit der fraktionierten Ifosfamid-Stosstherapie bei generalisierten malignen Tumoren. Med Welt 26:972–979, 1975.

    PubMed  CAS  Google Scholar 

  15. Stuart-Harris RC, Harper PG, Parsons CA, et al. High dose alkylating therapy using ifosfamide infusion with mesna in the treatment of adult advanced soft tissue sarcoma. Cancer Chemother Pharmacol 11:69–72, 1983.

    Article  PubMed  CAS  Google Scholar 

  16. Bramwell VHC, Mouridsen HT, Santoro A, et al. Cyclophosphamide versus ifosfamide: Final report of a randomised phase II trial in adult soft tissue sarcoma. Eur J Cancer 23:311–321, 1987.

    Article  CAS  Google Scholar 

  17. Pinedo HM, Bramwell VHC, Mouridsen HT, et al. Chemotherapy of advanced soft tissue sarcoma in adults. Cancer Treat Rev 4:67–86, 1977.

    Article  PubMed  CAS  Google Scholar 

  18. Pazdur R, Samson MK, Baker L. Fludarabine phosphate: Phase II evaluation in advanced soft tissue sarcomas. Am J Clin Oncol 10:341–343, 1987.

    Article  PubMed  CAS  Google Scholar 

  19. Kurzrock R, Yap BS, Plager C, et al. Phase II evaluation of PALA in patients with refractory metastatic sarcomas. Am J Clin Oncol 7:305–307, 1984.

    Article  PubMed  CAS  Google Scholar 

  20. Casper ES, Baselga J, Smart TB, Magill GB, Markman M, Ranhosky A. A phase II trial of PALA plus dipyridamole in patients with advanced soft tissue sarcoma. Cancer Chemother Pharmacol 28:51–54, 1991.

    Article  PubMed  CAS  Google Scholar 

  21. Licht JD, Gonin R, Antman K. A phase II trial of trimetrexate in patients with advanced soft tissue sarcoma. Cancer Chemother Pharmacol 28:223–225, 1991.

    Article  PubMed  CAS  Google Scholar 

  22. Eisenhauer EA, Wierzbicki R, Knowling M, Bramwell VHC, Quirt IC. Phase II trials of trimetrexate in advanced adult soft tissue sarcomas. Studies of the Canadian Sarcoma Group and National Cancer Institute of Canada Clinical Trials Group. Ann Oncol 2:689–690, 1991.

    PubMed  CAS  Google Scholar 

  23. Casper ES, Christman KL, Schwartz GK, Johnson B, Brennan MF, Bertino JR. Edatrexate in patients with soft tissue sarcoma. Activity in malignant fibrous histiocytoma. Cancer 72:766–770, 1993.

    Article  PubMed  CAS  Google Scholar 

  24. Borden EC, Amato DA, Edmonson JH, Ritch PS, Shiraki M. Randomised comparison of doxorubicin and vindesine to doxorubicin for patients with metastatic soft tissue sarcomas. Cancer 66:862–867, 1990.

    Article  PubMed  CAS  Google Scholar 

  25. van Hoesel QGCM, Verweij J, Catimel G, et al. Phase II study with docetaxel (taxotere) in advanced soft tissue sarcomas of the adult. Ann Oncol 5:539–542, 1994.

    PubMed  Google Scholar 

  26. Blackstein ME, Eisenhauer EA, Bramwell V, Belanger K, Verma S, Beare S. Docetaxel (taxotere) as first line therapy for metastatic or recurrent soft tissue sarcoma: A phase II trial. Eur J Cancer 31A(Suppl 5):S177, 1995.

    Article  Google Scholar 

  27. Gian V, Lynch J, McCarley D, Johnson T. Taxol in the treatment of recurrent or metastatic soft tissue or osteosarcomas. Proc Am Soc Clin Oncol 14:516, 1995.

    Google Scholar 

  28. Buesa JM, Mouridsen HT, van Oosterom AT, et al. High dose DTIC in advanced soft tissue sarcomas of the adult. A phase II study of the EORTC Soft Tissue and Bone Sarcoma Group. Ann Oncol 2:307–309, 1991.

    PubMed  CAS  Google Scholar 

  29. Bernard SA, Capizzi RL, Rudnick SA, Tremont SJ, Raymond RN. A one day combination chemotherapy (CyVADIC) regimen in soft tissue sarcomas. Proc Am Soc Clin Oncol 1:170, 1982.

    Google Scholar 

  30. karakousis CP, Holterman OA, Holyoke E. Cisdichlorodiamineplatinum (II) in metastatic soft tissue sarcomas. Cancer Treat Rep 63:2071–2075, 1979.

    PubMed  CAS  Google Scholar 

  31. Goldstein D, Cheuvert B, Trump DL, et al. Phase II trial of carboplatin in soft tissue sarcoma. Am J Clin Oncol 13:420–423, 1990.

    Article  PubMed  CAS  Google Scholar 

  32. Eisenhauer EA, Wainman N, Boos G, MacDonald D, Bramwell V. Phase II trials of topotecan in patients with malignant gliomas and soft tissue sarcoma. Proc Am Soc Clin Oncol 14:175, 1995.

    Google Scholar 

  33. Welt S, Magill GB, Sordillo PP, et al. Phase II trial of VP-16213 in adults with soft tissue sarcomas. Proc Am Soc Clin Oncol 2:234, 1983.

    Google Scholar 

  34. Nissen NI, Pajak TF, Leone LA, et al. Clinical trial of VP-16213 (NSC 141540) iv twice weekly in advanced neoplastic disease. Cancer 45:232–235, 1980.

    Article  PubMed  CAS  Google Scholar 

  35. EORTC Clinical Screening Group. Epidophyllotoxin VP16213 in treatment of leukemias, haematosarcomas and solid tumours. Br Med J 3:199–202, 1973.

    Article  Google Scholar 

  36. Blair SC, Zalupski MM, Baker LH. Ifosfamide and etoposide in the treatment of advanced soft tissue sarcomas. Am J Clin Oncol 17:480–484, 1994.

    Article  PubMed  CAS  Google Scholar 

  37. Gottlieb JA. Combination chemotherapy for metastatic sarcoma. Cancer Chemother Rep 58:265–270, 1974.

    PubMed  CAS  Google Scholar 

  38. Gottlieb JA, Baker LH, Quagliani JM, et al. Chemotherapy of sarcomas with a combination of Adriamycin and dimethyl triazeno imidazole carboxamide. Cancer 30:1632–1638, 1972.

    Article  PubMed  CAS  Google Scholar 

  39. Gottlieb JA, Benjamin RS, Baker LH, et al. Role of DTIC (NDC 45388) in the chemotherapy of sarcomas. Cancer Treat Rep 60:199–203, 1976.

    PubMed  CAS  Google Scholar 

  40. Wagner DE, Ramirez G, Weiss AJ. Combination phase I-II study of imidazole carboxamide (NSC-45388). Oncology 26:310–316, 1972.

    Article  PubMed  CAS  Google Scholar 

  41. Creagan ET, Hahn RG, Ahmann DL, Edmonson J, Bisel HF, Eagan RT. A comparative clinical trial evaluating the combination of Adriamycin, DTIC and vincristine, the combination of actinomycin D, cyclophosphamide and vincristine, and a single agent methyl CCNU in advanced sarcoma. Cancer Treat Rep 60:1385–1387.

    Google Scholar 

  42. Yap B, Baker LH, Sinkovics JG, et al. Cyclophosphamide, vincristine, Adriamycin and DTIC (CYVADIC) combination chemotherapy for the treatment of advanced sarcomas. Cancer Treat Rep 64:93–98, 1980.

    PubMed  CAS  Google Scholar 

  43. Yap BS, Sinkovics JG, Benjamin RS, et al. Survival and relapse patterns of complete respond-ers in adults with advanced soft tissue sarcomas. Proc Am Assoc Cancer Res 20:352, 1979.

    Google Scholar 

  44. Santoro A, Tursz T, Mouridsen H, et al. Doxorubicin versus CyVADIC versus doxorubicin plus ifosfamide in first-line treatment of advanced soft tissue sarcomas: A randomised study of the EORTC Soft Tissue and Bone Sarcoma Group. J Clin Oncol 13:1537–1545, 1995.

    PubMed  CAS  Google Scholar 

  45. Elias A, Ryan L, Sulkes A, et al. Response to mesna, doxorubicin, ifosfamide and dacarbazine in 108 patients with metastatic or unresectable sarcoma and no prior chemotherapy. J Clin Oncol 7:1208–1216, 1989.

    PubMed  CAS  Google Scholar 

  46. Benjamin RS, Yap BS. Infusion chemotherapy for soft tissue sarcomas. In LH Baker, ed. Soft Tissue Sarcomas. The Hague, Netherlands: Martinus Nijhoff, 1987.

    Google Scholar 

  47. Mansi JL, Fisher C, Wiltshaw E, Macmillan S, King M, Stuart-Harris R. A phase I-II study of ifosfamide in combination with Adriamycin in the treatment of adult soft tissue sarcoma. Eur J Cancer Clin Oncol 24:1439–1443, 1988.

    Article  PubMed  CAS  Google Scholar 

  48. Schutte J, Mouridsen HT, Steward WP, et al. Adriamycin plus ifosfamide in previously untreated patients with advanced soft tissue sarcomas. Eur J Cancer 26:558, 1990.

    Article  PubMed  CAS  Google Scholar 

  49. Elias A, Antman KH. Doxorubicin, ifosfamide and dacarbazine (AID) with mesna uroprotection for advanced untreated sarcoma: A phase I study. Cancer Treat Rep 70:827–833, 1986.

    PubMed  CAS  Google Scholar 

  50. Elias AD, Ryan L, Aisner J, Antman KH. Doxorubicin, ifosfamide and DTIC for advanced untreated sarcoma. Proc Am Soc Clin Oncol 6:134, 1987.

    Google Scholar 

  51. Borden EC, Amato D, Enterline HT, et al. Randomised comparison of Adriamycin regimens for treatment of metastatic soft tissue sarcomas. J Clin Oncol 5:840–850, 1987.

    PubMed  CAS  Google Scholar 

  52. Benjamin RS, Gottlieb JA, Baker LH. CYVADIC versus CYVADACT — a randomised trial of cyclophosphamide, vincristine and Adriamycin plus either dacarbazine or actinomycin D for advanced soft tissue sarcomas. Proc Am Assoc Cancer Res 17:256, 1976.

    Google Scholar 

  53. Baker LH, Frank J, Fine G, et al. Combination chemotherapy using Adriamycin, DTIC, cyclophosphamide and actinomycin D for advanced soft tissue sarcomas. A randomised comparative trial. J Clin Oncol 5:851–861, 1987.

    PubMed  CAS  Google Scholar 

  54. Zalupski M, Metch B, Balcerzak S, et al. Phase III comparison of doxorubicin and dacarbazine given by bolus versus infusion in patients with soft tissue sarcomas. A Southwest Oncology Group Study. J Natl Cancer Instit 83:926–932, 1991.

    Article  CAS  Google Scholar 

  55. Antman K, Crowley J, Balcerzak SP, et al. An Intergroup phase III randomised study of doxorubicin and dacarbazine with or without ifosfamide and mesna in advanced soft tissue and bone sarcomas. J Clin Oncol 11:1276–1285, 1993.

    PubMed  CAS  Google Scholar 

  56. Wiltshaw E, Westbury G, Harmer C, McKinna A, Fisher C. Ifosfamide plus mesna with and without Adriamycin in soft tissue sarcoma. Cancer Chemother Pharmacol 18:S10–S12, 1986.

    Article  PubMed  Google Scholar 

  57. Steward WP, Verweij J, Somers R, et al. Granulocyte-macrophage colony-stimulating factor allows safe escalation of dose-intensity of chemotherapy in metastatic adult soft tissue sarcomas: A study of the EORTC Soft Tissue and Bone Sarcoma Group. J Clin Oncol 11:15–21, 1993.

    PubMed  CAS  Google Scholar 

  58. Edmonson JH, Long HJ, Kvols LK. Cytotoxic drugs plus subcutanous granulocyte macrophage colony stimulating factor: Can molgramostim enhance antisarcoma therapy? J Natl Cancer Inst 86:312–314

    Google Scholar 

  59. Hoekman K, Wagstaff J, van Groeningen CJ, Vermorken JB, Meyer S, Pinedo HM. The treatment of advanced soft tissue sarcoma with high dose doxorubicin plus granulocytemacrophage colony-stimulating factor. Ann Oncol, in press.

    Google Scholar 

  60. Brain E, DeLesne A, LeChevalier T, et al. High dose ifosfamide can circumvent resistance to Standard dose ifosfamide in advanced soft tissue sarcomas. Proc Am Soc Clin Oncol 12:470, 1993.

    Google Scholar 

  61. Cerny T, Leyvraz S, Daggi H, Varini M, Kroner T, Marti C. Phase II trials of ifosfamide and mesna in advanced sfot tissue sarcoma patients. Proc Am Soc Clin Oncol 11:416, 1992.

    Google Scholar 

  62. Christman KL, Crapes ES, Schwartz EK. High intensity scheduling of ifosfamide in adult patients with soft tissue sarcomas. Proc Am Soc Clin Oncol 12:470, 1993.

    Google Scholar 

  63. Dumontet C, Biron P, Bouffet E, et al. High dose chemotherapy with ABMT in soft tissue sarcomas: A report of 22 cases. Bone Marrow Transplan 10:405–408, 1992.

    CAS  Google Scholar 

  64. Blay JY, Bouhour D, Brunat-Mentigny M, et al. High dose chemotherapy (VIC) and bone marrow support in advanced sarcomas. Proc Am Soc Clin Oncol 13:479, 1994.

    Google Scholar 

  65. Kessinger A, Petersen K, Bishop M, Schmit-Pokorny K. High dose therapy with autologous hematopoietic stem cell rescue for patients with metastatic soft tissue sarcoma. Proc Am Soc Clin Oncol 13:480, 1994.

    Google Scholar 

  66. Salem PA, Benjamin RS, Howard J, Gutterman JU. Phase II trial of recombinant interferon alpha-2b in the treatment of advanced metastatic and refractory sarcomas. Proc Am Assoc Cancer Res 32:200, 1991.

    Google Scholar 

  67. Papadopoulos NEJ, Patel SR, Linke K, Benjamin RS. A phase II study of 5-fluorouracil infusion and interferon alpha in metastatic sarcomas. Proc Am Assoc Cancer Res 33:229, 1992.

    Google Scholar 

  68. Blum PH, Powers TV, Downey AM, et al. rhGM-CSF for adult soft tissue sarcomas. Proc Am Soc Clin Oncol 12:474, 1993.

    Google Scholar 

  69. Rosenberg SA, Lotze MT, Muul LM, et al. A progress report on the treatment of 157 patients with advanced cancer using lymphokine-activated killer cells and IL-2 or high dose IL-2 alone, N Engl J Med 316:889–897, 1987.

    Article  PubMed  CAS  Google Scholar 

  70. Rosso R, Sertoli MR, Queirolo P, et al. An outpatient phase I study of a subcutaneous interleukin-2 and intramuscular alpha-2a-interferon combination in advanced malignancies. Ann Oncol 3:559–563, 1992.

    PubMed  CAS  Google Scholar 

  71. Verweij J, Judson I, Steward W, et al. Phase II study of liposomal muramyl tripeptide phosphatidylethonolamine (MTP/PE) in advanced soft tissue sarcomas of the adult. An EORTC Soft Tissue and Bone Sarcoma Group Study. Eur J Cancer, 30:842–843, 1994.

    Article  Google Scholar 

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Steward, W.P. (1997). Chemotherapy for metastatic soft tissue sarcomas. In: Verweij, J., Pinedo, H.M., Suit, H.D. (eds) Soft Tissue Sarcomas: Present Achievements and Future Prospects. Cancer Treatment and Research, vol 91. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-6121-7_11

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