Monday, May 5, 2008

Epithelioid sarcoma: the University of Washington experience.

A forthcoming issue of the American Journal of Surgery has an article on ES:

Epithelioid sarcoma: the University of Washington experience.

Wolf PS, Flum DR, Tanas MR, Rubin BP, Mann GN.
University of Washington Medical Center, Seattle, WA 98195, USA.
BACKGROUND: Epithelioid sarcoma is a rare sarcoma with a high local recurrence rate that frequently metastasizes to lymph nodes. We reviewed our experience with adjuvant therapy in patients with this disease. METHODS: Between 1990 and 2003, we treated 11 patients with epithelioid sarcoma. Patient, tumor, and treatment characteristics were analyzed, and effect of treatment on survival was evaluated by the Kaplan-Meier method. RESULTS: Nine men and 2 women were treated. Tumors presented on the trunk, the upper extremities, and the lower extremities. Five patients developed nodal disease. All patients underwent surgery for the primary tumor, and 7 patients had nodal evaluation. Ten patients underwent adjuvant chemotherapy, and 9 underwent radiotherapy. Recurrence developed in 9 patients. Five-year disease-free and overall survival rates were 46% and 65%, respectively. Chemotherapy and radiation therapy did not impact disease-free survival. CONCLUSIONS: Although surgery remains the primary treatment modality, multi-institutional trials are needed to develop more effective adjuvant therapy for patients with epithelioid sarcoma.

No blockbusters here, though I found it interesting just how heavily men were represented in the series (9 out of 11) and how common presentations in the trunk (5 out of 11) were. Forty-five percent of the group had nodal mets -- the UW authors throw out a range from other studies of 22 to 48 percent. Like pretty much everyone else, the authors here are convinced that a big tumor and node problems are bad news. The authors don't find any benefit to chemo, but the series ended in 2003 so most of the patients received adriamycin/ifosfamide-based therapy.

Lemme know by e-mail if you want a copy.


Sachin Palewar said...

Hey nice blog. I am from India. My wife has ES. Her toe was surgically removed abt 2.5 yrs. back. She had pleural effusion and it confirmed mets to her lungs. She is now undergoing Adria, Ifo, Mesna chemocycle. Effusion stopped. But from your blog I get the impression that Adria and Ifo combination is very old. Do you think there are any new drugs available now which should be used instead of Adria and Ifo?

Please let me know as it can be a lot of help to me. Not many people know about it in India.

Thanks for your help and I hope for your speedy recovery as well.

SG said...

The combination IS old, but it's the first-line chemo because adriamycin/doxrubicin is the most proven effective agent against soft-tissue sarcoma. And if it's working, you want to ride it out... Typical second-line chemo is gemcitabine combined with docetaxel -- these drugs could be a future option to discuss with your doctor.

The big new thing out there is deforolimus, which is in a big trial now: SUCCEED. It claims to be a global trial, so maybe there could be a trial site in India if your doctor pushed for one. It's not a curative drug, though. The idea with it is that if you respond to chemo, you go on this stuff (which has mild side-effects) and it ideally would buy you time without the disease growing or spreading. The bad part is that the study is double-blind, placebo-controlled.

SG said...

I want to apologize for sounding dismissive of AIM -- or implying that there's something new and dramatically better out there. Alas, ES is highly chemoresistant, and no magic bullet has emerged. I'll be watching the summer meeting reports, and will post the ES stuff I can find. My best to your family.

Sachin Palewar said...

Hey SG,

Thanks for your response and clarifications. I appreciate you sharing all such things when you are yourself going through a lot I guess.

Anyway lets all of us be strong and fight it out.

Thanks and I wish you all the best as well.