Shreyaskumar Patel, M.D.Shreyaskumar Patel, M.D.
Center Medical Director,Center Medical Director, Sarcoma CenterSarcoma Ce...
Soft-Tissue
Sarcomas
2008 Incidence
10,390 new cases
>50 different
subtypes
SOFT-TISSUE SARCOMAS
Cytological Classification
Pleomorphic / Spindle cell
variants
MFH
Unclassified Sarcoma
Liposarcoma
L...
SOFT-TISSUE
SARCOMAS
CHEMOTHERAPEUTIC
AGENTS
Anthracycline +/- Ifosfamide• MFH / PUS
• Unclassified Sarcoma
• Liposarcoma
...
SOFT-TISSUE
SARCOMAS
CHEMOTHERAPEUTIC
AGENTS
Gemcitabine +/- Taxotere• Leiomyosarcoma (Gyn and
others)
• Angiosarcoma
• Li...
SOFT-TISSUE
SARCOMAS
CHEMOTHERAPEUTIC
AGENTS
Trabectedin• Leiomyosarcoma
• Liposarcoma
• MFH
• Endometrial stromal sarcoma...
SOFT-TISSUE
SARCOMAS
CHEMOTHERAPEUTIC
AGENTS
Miscellaneous• DTIC (dacarbazine) for
leiomyosarcomas
• Paclitaxel for angios...
SOFT-TISSUE SARCOMAS
Poor sensitivity to standard
therapy
• Fibrosarcoma
• Sarcomatoid mesothelioma
(pleural or peritoneal...
SOFT-TISSUE
SARCOMAS
CHEMOTHERAPEUTIC
AGENTS
Hormonal therapy• Tamoxifen for desmoid tumors
• Megace / AI for ESS
• Hormon...
SOFT-TISSUE
SARCOMAS
Targeted therapy
• Desmoids, DFSP - Imatinib
• Hemangioendotheliomas / Angiosarcomas -
Bevacizumab, S...
SYSTEMIC THERAPY FOR
STS
Future Directions
• Need new agents
– Preferably with an improved therapeutic
ratio
• ? Add biolo...
Shreyaskumar Patel, M.D.Shreyaskumar Patel, M.D.
Center Medical Director,Center Medical Director, Sarcoma CenterSarcoma Ce...
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  1. 1. Shreyaskumar Patel, M.D.Shreyaskumar Patel, M.D. Center Medical Director,Center Medical Director, Sarcoma CenterSarcoma Center Professor of Medicine, Deputy ChairmanProfessor of Medicine, Deputy Chairman Dept. of Sarcoma Medical OncologyDept. of Sarcoma Medical Oncology Texas Medical CenterTexas Medical Center Houston, TexasHouston, Texas Rational choice of WHICH chemotherapy for Spindle cell soft-tissue sarcomas
  2. 2. Soft-Tissue Sarcomas 2008 Incidence 10,390 new cases >50 different subtypes
  3. 3. SOFT-TISSUE SARCOMAS Cytological Classification Pleomorphic / Spindle cell variants MFH Unclassified Sarcoma Liposarcoma Leiomyosarcoma Synovial Sarcoma Rhabdomyosarcoma MPNST Angiosarcoma GIST Desmoid DFSP Hemangioendothelioma Hemangiopericytoma / SFT Extraskeletal Chondrosarcoma Extraskeletal Osteosarcoma Endometrial Stromal Sarcoma Mesothelioma Fibrosarcoma
  4. 4. SOFT-TISSUE SARCOMAS CHEMOTHERAPEUTIC AGENTS Anthracycline +/- Ifosfamide• MFH / PUS • Unclassified Sarcoma • Liposarcoma • Synovial Sarcoma • Rhabdomyosarcoma • Angiosarcoma • MPNST
  5. 5. SOFT-TISSUE SARCOMAS CHEMOTHERAPEUTIC AGENTS Gemcitabine +/- Taxotere• Leiomyosarcoma (Gyn and others) • Angiosarcoma • Liposarcoma • MFH • Unclassified sarcoma • Synovial sarcoma
  6. 6. SOFT-TISSUE SARCOMAS CHEMOTHERAPEUTIC AGENTS Trabectedin• Leiomyosarcoma • Liposarcoma • MFH • Endometrial stromal sarcoma • Synovial sarcoma • Others
  7. 7. SOFT-TISSUE SARCOMAS CHEMOTHERAPEUTIC AGENTS Miscellaneous• DTIC (dacarbazine) for leiomyosarcomas • Paclitaxel for angiosarcomas • Topotecan / Irinotecan for rhabdomyosarcomas • Temodar + Avastin for HPC / SFT
  8. 8. SOFT-TISSUE SARCOMAS Poor sensitivity to standard therapy • Fibrosarcoma • Sarcomatoid mesothelioma (pleural or peritoneal) • Extraskeletal myxoid chondrosarcoma
  9. 9. SOFT-TISSUE SARCOMAS CHEMOTHERAPEUTIC AGENTS Hormonal therapy• Tamoxifen for desmoid tumors • Megace / AI for ESS • Hormonal therapy for LMS of gynecologic origin
  10. 10. SOFT-TISSUE SARCOMAS Targeted therapy • Desmoids, DFSP - Imatinib • Hemangioendotheliomas / Angiosarcomas - Bevacizumab, Sunitinib, Sorafenib, Pazopanib… • mTOR inhibitors - Deforolimus - ? Non- specific • Synovial Sarcoma - EGFR inhibitors, DR Agonists • MPNST - EGFR inhibitors, Raf inhibitors • Well-diff / Dedifferentiated liposarcoma -
  11. 11. SYSTEMIC THERAPY FOR STS Future Directions • Need new agents – Preferably with an improved therapeutic ratio • ? Add biologics to chemotherapy – ? Anti-angiogenic agents, small molecules… • Molecular testing a’la Breast Cancer – Identify patients who need and are likely to benefit from systemic therapy
  12. 12. Shreyaskumar Patel, M.D.Shreyaskumar Patel, M.D. Center Medical Director,Center Medical Director, Sarcoma CenterSarcoma Center Professor of Medicine, Deputy ChairmanProfessor of Medicine, Deputy Chairman Dept. of Sarcoma Medical OncologyDept. of Sarcoma Medical Oncology Texas Medical CenterTexas Medical Center Houston, TexasHouston, Texas Rational choice of WHICH chemotherapy for spindle cell soft-tissue sarcomas
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