Ongoing Research With Novel Approaches Continues in Uterine Sarcomas

Brian Van Tine, MD

Despite extensive research efforts, clinical trials remain the standard of care for patients with uterine sarcomas, said Brian Van Tine, MD.

“This year, [the 2019 ASCO Annual Meeting] was full of a lot of learning lessons about negative trials; we didn’t really have a lot of game changers,” said Van Tine, an associate professor in the Department of Medicine, director, Sarcoma Program, Division of Medical Oncology, Washington University School of Medicine in St. Louis.

However, promising agents are under clinical investigation for rare tumors, such as perivascular epithelioid cell tumors (PEComa) and endothelial sarcoma, he added.

In an interview during the 2019 OncLive^® State of the Science Summit™ on Ovarian Cancer and Soft Tissue Sarcoma, Van Tine highlighted the latest developments in soft tissue sarcoma (STS), including data from key trials and further research being conducted in the rare tumor field.

OncLive: What key advances have been made in STS?

Van Tine: At the State of the Science Summit™, we not only discussed all the advances made in ovarian cancer, but we also got a chance to talk about the recent data that was just released at the 2019 ASCO Annual Meeting on sarcoma.

There was a Twitter poll put out by OncLive asking what agents [we] would use in a patient with leiomyosarcoma who had gemcitabine and docetaxel 2 years ago and 25% of the respondents actually recommended the doxorubicin plus olaratumab, which had just been shown to be an inactive agent in a randomized phase III trial [presented at the 2019 ASCO Annual Meeting]. [This is why] the State of the Science Summit^TM events are so important. There’s so much knowledge that needs to be disseminated.

Unfortunately, the olaratumab data were negative, and because of that, we got to focus on the GeDDiS trial and whether or not to use gemcitabine/docetaxel or doxorubicin as frontline [treatment]. We talked about [the article by] William D. Tapp, MD, of Memorial Sloan Kettering Cancer Center, that was published in Lancet Oncology, in which the GeDDiS trial was published and [weighed the] pros and cons of both options. It comes down to the patient and the situation you’re in since they do have the same OS and PFS [benefit], although doxorubicin can be a little less toxic.

Then, finally, I reminded most of my gynecologic colleagues about trabectedin (Yondelis) and the work that is ongoing with gemcitabine transporters, which is kind of the new state of the science and where the field is headed.

What is the role of trabectedin in sarcoma?

It’s important to remind everyone that trabectedin is there and it’s a very active agent; it’s very useful for uterine and nonuterine leiomyosarcoma and liposarcoma. There are important factors that I believe are important to remember.

First, you can treat patients as an outpatient; you don’t have to admit them [to receive that treatment]. Second, I like to remind people about rhabdomyolysis, which is one of the adverse events that can be easily missed. When patients start complaining of dull aches and pains, sometimes it’s very important to check for the liver toxicities and the various safety issues with trabectedin. However, it’s a drug where [patients] don’t really lose their hair; this is important because [we need] agents that are hair-preserving and that are very focused on quality of life.

Was there any other key research presented at the 2019 ASCO Annual Meeting that you would like to highlight?

There were a few [promising] drugs for very rare diseases. For example, there’s a new mTOR inhibitor that’s given intravenously for patients with PEComa, and it looks like it’s headed toward FDA approval. There’s also a drug, tazemetostat, that looks really, really promising for endothelial sarcoma and is moving forward in future clinical trials.

Could you speak to the importance of collaboration in this field?

I believe it’s important to remember that the sarcoma field is a partner—especially with uterine leiomyosarcoma and endometrial stromal sarcoma. We work well together. We have many trial options and we would like to be able to reach out to them as we share patients. They are amazing surgeons and the surgical outcomes we get in our partnership are highly valued.

What is the key take-home message from your presentation?

Clinical trials are still the standard of care for sarcoma. Every patient should be given every opportunity, if they can get to a sarcoma center, to participate in hopefully what will be the future [standard of care]. If we don’t put patients on trials, we’re going to stay with the results we have for today, which really do need to be improved.