Soft Tissue Sarcoma Update, Issue 1, 2017 (Video Program)Biology, incidence and management of sarcomas
3:22 minutes.
TRANSCRIPTION:
DR VAN TINE: The first thing that the general medical oncologist has to realize is that the parallel word to sarcoma is actually carcinoma, not, say, breast cancer or lung cancer. Sarcomas represent a group of up to 100 different diseases, depending on how they count them — some benign, some heavily aggressively malignant — that all have different biology, have underlying different genetics and actually are just, frankly, very different diseases with different approaches. And so as you kind of get down to the next level of what do they have in common, the actually only thing they have in common is the mesenchymal origin. And so it’s everything that arises from something that holds you together, so bones, cartilage, fat, muscle, et cetera. There’s about 15,000 cases. They guess that this is about 1% of the incidence. We still suffer from the lack of an ICD9 or 10 code. And so a lot of the sarcoma practitioners, there’s about 40 of them in the US, medical oncologists that solely focus on sarcoma, feel this number is probably an underestimate based on just adding the incidence of all the diseases together. As a whole, you wouldn’t take prostate cancer, lung cancer, breast cancer, give them a single agent and expect to see a lot of activity. But this is what we’ve traditionally done in sarcoma with things like doxorubicin, and then seen really low response rates. And then wondered why we’ve had a bad time actually finding agents that actually work across the spectrum of different diseases. But individually, when you take things like synovial sarcoma, for example, you find that they’re highly sensitive to a lot of different chemotherapies and they’re responsive to many things. Whereas if you get to something like a well-differentiated liposarcoma, you find that giving those — chemo in the first place is probably not ever warranted. And so especially with the introduction of pazopanib and then trabectedin and eribulin, these are now coming in where they’re getting histology focuses. And the guidelines are actually split up along a lot of different histologies in the NCCN Guidelines on purpose. Because different agents are shown to have different activity in different diseases. And so I think the statement in the NCCN Guidelines about sarcoma is important, which is that — and these words are carefully chosen — the guidance for the treatment of sarcoma should come from a multidisciplinary group with an extensive experience in sarcoma. They didn’t say “treat.” And I think that’s really important. I think that bringing the right agents to the right sarcoma in the right order is not the 1970s anymore where everything got doxorubicin and we were done. Now there’s this cascade where an epithelioid sarcoma is probably the cascade of things you do by line. It’s very different than, say, a leiomyosarcoma. And so as we get into this, histology matters and experience matters. Because this is a large group of diseases where if you see it all the time, you really do treat it a little bit differently than if you’re looking it up. And this is why I think the partnership that really needs to be formed would be formed between the general oncologist and the sarcoma centers is a very important relationship that I work very hard in the Midwest to foster. |