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Response to trabectedin in a patient with advanced synovial sarcoma with lung metastases.

Zanardi E, Maruzzo M, Montesco MC, Roma A, Rastrelli M, Basso U - Anticancer Drugs (2014)

Bottom Line: A partial radiological response was achieved; dosage was reduced to 1.1 mg/m because of mild asthenia, grade 3 neutropenia, grade 3 nausea and vomiting, and reversible transaminase elevation.After 9 months of treatment, the lung nodules progressed, the patient received sorafenib, but further progressed and died 19 months after the first appearance of lung metastases.We believe that trabectedin represents an attractive option for the treatment of metastatic synovial sarcoma and further clinical studies are warranted.

View Article: PubMed Central - PubMed

Affiliation: Departments of aMedical Oncology Unit I bPathology cMelanoma and Sarcoma Unit, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy.

ABSTRACT
Trabectedin is an alkylating agent registered in Europe for the treatment of advanced metastatic soft-tissue sarcomas, whose activity has been documented mainly in liposarcomas or leiomyosarcomas. Here, we report the response achieved in a patient with lung metastases from synovial sarcoma. A man with a large synovial sarcoma of the axilla underwent three cycles of neoadjuvant epirubicin+ifosfamide before complete excision, followed by three additional cycles of chemotherapy and radiotherapy. After 14 months, bilateral lung metastases appeared and were first treated with a prolonged 14-day continuous infusion of high-dose ifosfamide without response, and then with second-line trabectedin. A partial radiological response was achieved; dosage was reduced to 1.1 mg/m because of mild asthenia, grade 3 neutropenia, grade 3 nausea and vomiting, and reversible transaminase elevation. After 9 months of treatment, the lung nodules progressed, the patient received sorafenib, but further progressed and died 19 months after the first appearance of lung metastases. Trabectedin was the only drug that led to a radiological response in this patient with synovial sarcoma, despite being administered at 75% of the standard dose because of dose-limiting nausea and vomiting, in line with more recent data demonstrating activity in translocated sarcomas. We believe that trabectedin represents an attractive option for the treatment of metastatic synovial sarcoma and further clinical studies are warranted.

No MeSH data available.


Related in: MedlinePlus

Computed tomography (CT) scans taken before trabectedin therapy showing lung metastases (left-hand images) and response to 5 months of trabectedin therapy showing lung metastases considerably reduced in size and density (right-hand images).
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Figure 1: Computed tomography (CT) scans taken before trabectedin therapy showing lung metastases (left-hand images) and response to 5 months of trabectedin therapy showing lung metastases considerably reduced in size and density (right-hand images).

Mentions: After the first three cycles of treatment, a CT scan showed that the lung metastases had reduced in size; thus, trabectedin was continued at the same dose of 1.1 mg/m2 for three additional cycles. A partial radiological response according to Response Evaluation Criteria in Solid Tumors criteria was achieved on August 2011, when some lesions had even disappeared (Fig. 1). Multifocality discouraged metastasectomy and therefore the patient continued chemotherapy for three additional cycles, with persistence of grade 2 nausea.


Response to trabectedin in a patient with advanced synovial sarcoma with lung metastases.

Zanardi E, Maruzzo M, Montesco MC, Roma A, Rastrelli M, Basso U - Anticancer Drugs (2014)

Computed tomography (CT) scans taken before trabectedin therapy showing lung metastases (left-hand images) and response to 5 months of trabectedin therapy showing lung metastases considerably reduced in size and density (right-hand images).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222791&req=5

Figure 1: Computed tomography (CT) scans taken before trabectedin therapy showing lung metastases (left-hand images) and response to 5 months of trabectedin therapy showing lung metastases considerably reduced in size and density (right-hand images).
Mentions: After the first three cycles of treatment, a CT scan showed that the lung metastases had reduced in size; thus, trabectedin was continued at the same dose of 1.1 mg/m2 for three additional cycles. A partial radiological response according to Response Evaluation Criteria in Solid Tumors criteria was achieved on August 2011, when some lesions had even disappeared (Fig. 1). Multifocality discouraged metastasectomy and therefore the patient continued chemotherapy for three additional cycles, with persistence of grade 2 nausea.

Bottom Line: A partial radiological response was achieved; dosage was reduced to 1.1 mg/m because of mild asthenia, grade 3 neutropenia, grade 3 nausea and vomiting, and reversible transaminase elevation.After 9 months of treatment, the lung nodules progressed, the patient received sorafenib, but further progressed and died 19 months after the first appearance of lung metastases.We believe that trabectedin represents an attractive option for the treatment of metastatic synovial sarcoma and further clinical studies are warranted.

View Article: PubMed Central - PubMed

Affiliation: Departments of aMedical Oncology Unit I bPathology cMelanoma and Sarcoma Unit, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy.

ABSTRACT
Trabectedin is an alkylating agent registered in Europe for the treatment of advanced metastatic soft-tissue sarcomas, whose activity has been documented mainly in liposarcomas or leiomyosarcomas. Here, we report the response achieved in a patient with lung metastases from synovial sarcoma. A man with a large synovial sarcoma of the axilla underwent three cycles of neoadjuvant epirubicin+ifosfamide before complete excision, followed by three additional cycles of chemotherapy and radiotherapy. After 14 months, bilateral lung metastases appeared and were first treated with a prolonged 14-day continuous infusion of high-dose ifosfamide without response, and then with second-line trabectedin. A partial radiological response was achieved; dosage was reduced to 1.1 mg/m because of mild asthenia, grade 3 neutropenia, grade 3 nausea and vomiting, and reversible transaminase elevation. After 9 months of treatment, the lung nodules progressed, the patient received sorafenib, but further progressed and died 19 months after the first appearance of lung metastases. Trabectedin was the only drug that led to a radiological response in this patient with synovial sarcoma, despite being administered at 75% of the standard dose because of dose-limiting nausea and vomiting, in line with more recent data demonstrating activity in translocated sarcomas. We believe that trabectedin represents an attractive option for the treatment of metastatic synovial sarcoma and further clinical studies are warranted.

No MeSH data available.


Related in: MedlinePlus