DR LOVE: What do we know about these agents in soft tissue sarcoma?

DR POLLACK: Yes. So we don’t know that much. We know that there was the SARC 028 study that was presented at ASCO that treated 40 soft tissue sarcoma patients with pembrolizumab. And they saw a number of responses. They saw 4 responses in undifferentiated pleomorphic sarcoma. They saw a couple of responses in dedifferentiated liposarcoma. They saw a response in synovial sarcoma. They didn’t see any responses in leiomyosarcoma, like this patient has.

There was also a study of uterine leiomyosarcoma that was presented by Suzanne George. And they actually didn’t see any responses in their patients either. But that was also a small study with — I think it was 15 patients in that study. And we have actually seen a patient with prolonged stable disease with leiomyosarcoma that was treated off label with nivolumab.

So I think we’re still figuring it out. It’s really early in this history. There are a number of trials that are going to be coming soon, actually. At our center, we have a trial that just opened in the up-front setting of doxorubicin plus pembrolizumab. So that’s a trial that I’m really excited about. But I think for these patients, the kinds of responses that people have seen in melanoma and lung cancer and these other diseases, in sarcoma we just don’t know. And wouldn’t it be great if you have that chance of having a response?

And you think about the drugs that are really approved. I mean, now we have options of eribulin and trabectedin and pazopanib. So it’s great that we have these other options, but they all have a relatively small benefit for most patients in terms of the months of progression-free survival that they’re getting. And all these treatments have toxicities, so everybody really wants checkpoint inhibitors to be successful in sarcoma. And that’s why I think people are trying them off label.

Classification, incidence and management of sarcomas

Integration of the recently FDA-approved agents trabectedin and eribulin into the treatment algorithms for metastatic liposarcoma and leiomyosarcoma

Recent FDA approval of olaratumab in combination with doxorubicin and integration into the treatment algorithm for advanced STS

Role of tyrosine kinase inhibitors and immune checkpoint inhibitors in STS