Patterns of care and outcomes of patients with METAstatic soft tissue SARComa in a real-life setting: the METASARC observational study

BMC Medicine

Research Article

Antoine Giraud¹  Carine Bellera²  Marion Savina²  Jean-Yves Blay³  Isabelle Ray-Coquard³  Maud Toulmonde⁴  Sophie Cousin⁴  Antoine Italiano⁵  Olivier Mir⁶  Axel Le Cesne⁶  Dominique Ranchere-Vince⁷  François Le Loarer⁸  Philippe Terrier⁹  Marie-Pierre Sunyach^1,10  Paul Sargos^1,11  Cécile Le Péchoux^1,12  Pierre Meeus^1,13  Eberhard Stoeckle^1,14  Charles Honoré^1,15 

[1] Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France;Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France;ISPED, INSERM U1219 Bordeaux Population Health Center, Epicene Team, Bordeaux, France;Department of Medicine, Centre Leon Berard, Lyon, France;Department of Medicine, Institut Bergonié, Bordeaux, France;Department of Medicine, Institut Bergonié, Bordeaux, France;Early Phase Trials and Sarcoma Units, Institut Bergonié, 229 Cours de l’Argonne, Bordeaux, France;Department of Medicine, Institut Gustave Roussy, Villejui, France;Department of Pathology, Centre Leon Berard, Lyon, France;Department of Pathology, Institut Bergonié, Bordeaux, France;Department of Pathology, Institut Gustave Roussy, Villejuif, France;Department of Radiotherapy, Centre Leon Berard, Lyon, France;Department of Radiotherapy, Institut Bergonié, Bordeaux, France;Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France;Department of Surgery, Centre Leon Berard, Lyon, France;Department of Surgery, Institut Bergonié, Bordeaux, France;Department of Surgery, Institut Gustave Roussy, Villejuif, France;

关键词: Sarcoma;    Metastases;    Outcome;    Patterns of care;    Chemotherapy;    Surgery;   

DOI  :  10.1186/s12916-017-0831-7

 received in 2016-12-03, accepted in 2017-03-03,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundWell-designed observational studies of individuals with rare tumors are needed to improve patient care, clinical investigations, and the education of healthcare professionals.MethodsThe patterns of care, outcomes, and prognostic factors of a cohort of 2225 patients with metastatic soft tissue sarcomas who were diagnosed between 1990 and 2013 and documented in the prospectively maintained database of the French Sarcoma Group were analyzed.ResultsThe median number of systemic treatments was 3 (range, 1–6); 27% of the patients did not receive any systemic treatment and 1054 (49%) patients underwent locoregional treatment of the metastasis. Half of the patients who underwent chemotherapy (n = 810) received an off-label drug. Leiomyosarcoma was associated with a significantly better outcome than the other histological subtypes. With the exception of leiomyosarcomas, the benefit of a greater than third-line regimen was very limited, with a median time to next treatment (TNT) and overall survival (OS) ranging between 2.3 and 3.7 months and 5.4 and 8.5 months, respectively. The TNT was highly correlated with OS. Female sex, leiomyosarcoma histology, locoregional treatment of metastases, inclusion in a clinical trial, and treatment with first-line polychemotherapy were significantly associated with improved OS in the multivariate analysis.ConclusionsThe combination of doxorubicin with a second drug, such as ifosfamide, represents a valid option, particularly when tumor shrinkage is expected to provide clinical benefits. After failure of the second-line therapy, best supportive care should be considered, particularly in patients with non-leiomyosarcoma histology who are not eligible to participate in a clinical trial. Locoregional treatment of metastasis should always be included in the therapeutic strategy when feasible. TNT may represent a useful surrogate endpoint for OS in clinical studies.

【 授权许可】

CC BY   
© The Author(s). 2017