Keywords
Soft tissue sarcoma; Trofosfamide; Etoposide; Chemotherapy; Palliative treatment
Abstract
Background: Patients with a metastatic or locally advanced Soft Tissue Sarcoma (STS) are normally treated with chemotherapy. However, pretreated or vulnerable patients with comorbidities may have difficulties tolerating the intensive intravenous standard regimens. Trofosfomide, a peroral prodrug to ifosfamide, has been described to have promising effects in the treatment of STS. For childhood STS the combination of trofosfamide and etoposide has been used as maintenance therapy, but its utility in the treatment of adult STS has yet to be described.
Methods: A retrospective single center experience comprising of 69 adult patients with advanced STS, treated with Trofosfamide and Etoposide in combination (TE), is presented. The medical records, including pathology and radiology reports, of all patients who initiated TE between May 2002 and September 2015 were reviewed. We present data on duration of treatment, best radiological response and reason for ending treatment and side-effects. The treatment schedule consisted of oral trofosfamide 100 mg (total dose) twice a day from day 1-10, and oral etoposide 50 mg (total dose) twice a day from day 1-10, with a cycle length of 21 days.
Results: Among the 69 patients, the median treatment time was 103 days. A treatment time longer than 90 days were noted for 55.1%, and more than 180 days for 31.9 %. Patients with synovial sarcoma and well differentiated liposarcoma had the longest treatment times. Long treatment times were also noted in patients with other STS histologies. The treatment was well tolerated, regardless of patient age. Hematological toxicities however lead to dose-reductions and supportive measures in more than half of the cases. Three patients were diagnosed with MDS after long treatment times.
Conclusions: The combination of trofosfamide and etoposide is shown to be an effective and well tolerated treatment for adult patients with advanced STS of different histiotypes. TE is a good treatment option for heavily pretreated or vulnerable patients, e.g. caused by comorbidities. The risk for developing secondary cancer after treatment with TE should be considered.
Citation
Ahlstrom M, Sloth M and Eriksson M. Trofosfamide and Etoposide - A Well Tolerated Palliative Treatment for Adults with Advanced Soft Tissue Sarcoma: A Single Center Experience. SM J Sarcoma Res. 2017; 1(1): 1006.