DR LOVE: Let’s talk about the 2 therapies she got, the trabectedin and the eribulin, in terms of clinical research data and what your general experience is with these 2 drugs, how you use them and how that compared in this case.

DR POLLACK: Right. So now we have 2 FDA-approved treatments for liposarcoma. And we have trabectedin, which is also approved for leiomyosarcoma. And we have eribulin, which is approved just for liposarcoma.

In this case, I treated the patient with trabectedin first. I don't know if that’s the same decision I would make right now. I mean, I think that trabectedin has really great activity in the translocation-associated sarcomas, so myxoid/round cell liposarcoma really responds well to trabectedin. And we’ve had patients go years with stable disease on trabectedin who have translocation-associated sarcoma. So it’s approved for leiomyosarcoma and liposarcoma, but there’s a lot of data suggesting that it has activity in other translocation-associated sarcomas.

There was a Japanese study by Akira Kawai where they showed an overall survival benefit and a progression-free survival benefit when they randomized patients to receive either trabectedin or best supportive care. And we’ve treated a number of patients with synovial sarcoma that have had really durable stable disease and partial responses that are really durable with trabectedin.

Eribulin does well with all the liposarcomas. So all of the liposarcoma patients — not every patient, but all liposarcoma subtypes seem to benefit from eribulin. But pleomorphic liposarcoma seems to do really well with eribulin, as well as well/dedifferentiated liposarcoma. And myxoid/round cell liposarcoma also benefits from eribulin but maybe not as much as the other two.

So for me now, if I get a dedifferentiated liposarcoma, the order that I will typically do the therapy for a patient with metastatic disease is first eribulin and then trabectedin. They have different toxicity profiles. Trabectedin, a lot of patients will take trabectedin and they won’t have much toxicity at all. But then there’s other patients that react more like this patient, where they have a lot of fatigue, a lot of nausea, a lot of the typical chemotherapy toxicities. Other patients will just have some fatigue and nausea for the first few days after they get the drug. And then other patients basically, like, it’s nothing.

With eribulin, it’s a very well-tolerated chemotherapy. People do get some fatigue and some nausea. They can get some cytopenias. Neuropathy, of course. But it’s generally a well-tolerated drug. So I think that probably if I were to treat this patient again today with all the data that we have right now, I would probably order things with eribulin first and then trabectedin.

DR LOVE: Do most of your patients end up getting both of them, as this patient did?

DR POLLACK: I think most patients will end up getting both who have dedifferentiated liposarcoma. Usually these patients can go through a few different lines of treatment.

Classification, incidence and management of sarcomas

Integration of the recently FDA-approved agents trabectedin and eribulin into the treatment algorithms for metastatic liposarcoma and leiomyosarcoma

Recent FDA approval of olaratumab in combination with doxorubicin and integration into the treatment algorithm for advanced STS

Role of tyrosine kinase inhibitors and immune checkpoint inhibitors in STS