Stage IV and Recurrent Soft Tissue Sarcoma: Limbs, Outer Trunk, Head, or Neck

Overview

Patients diagnosed with stage IV soft tissue sarcoma (STS) have a cancer of any size or grade that has spread to distant parts of the body such as the lungs.

Sarcoma Centers & Second Opinions

Because sarcomas are uncommon it is important to find physicians who have experience with this disease. In the United States there are several locations that have physicians and teams dedicated to advancing the treatment of sarcoma. Patients with sarcoma should at least consider getting a second opinion at one of these centers. Click here to learn more about second opinions and click here to view a comprehensive list of sarcoma centers in the United States.

Treatment: Importance of Clinical Trials

Because research has not definitively demonstrated the best treatment for stage IV sarcomas, clinical trials are often considered a preferred strategy. It is important for patients to discuss the risks and benefits of participating in a clinical trial with their healthcare team. Learn more about clinical trials here.

Depending on the size of the cancer and whether the cancer is confined to one organ, local treatment might be an option. Local treatment could include a combination of surgery, radiation therapy, ablation, and/or embolization with or without chemotherapy. For patients with stage IV sarcoma whose cancer has spread to more than one organ, local or systemic therapy may be used to help control symptoms and improve quality of life.

Chemotherapy: Chemotherapy is a systemic treatment, meaning it can treat cancer cells anywhere in the body.  In 2015 the US Food and Drug Administration (FDA) approved two new chemotherapy drugs, Halaven® (eribulin mesylate) and Yondelis® (trabectedin), for the treatment of advanced STS.  Votrient® (pazopanib) was approved by the FDA for the treatment of advanced STS in 2012. Clinical trials are ongoing in order to determine how best to use these drugs as well as evaluating new drugs.

Yondelis is a chemotherapy agent that works by blocking certain types of proteins (transcription factors) that are involved in the copying and sending of tumor cell DNA. Clinical trial results have demonstrated that Yondelis improves outcomes compared to the standard agent, dacarbazine, in patients with advanced liposarcoma or leiomyosarcoma that has recurred or progressed following prior therapies.1

Halaven is a chemotherapy agent that works by causing abnormalities in microtubule formation in cells in order to prevent cell replication. Halaven was approved by the FDA based on clinical trial results directly comparing it to dacarbazine in STS patients with advanced liposarcoma. Overall survival almost doubled to 15.6 months for patients treated with Halaven, compared to only 8.4 months for patients treated with dacarbazine.2

Votrient is an oral medication known as a multi-targeted tyrosine kinase inhibitor. The drug works by interfering with the growth of new blood vessels that sarcomas need to survive. Clinical trial results have demonstrated that Votrient delays the time to cancer progression and increases overall survival in patients with advanced STS.3

Radiation Therapy: Radiation therapy uses high-energy x-rays to kill cancer cells and is considered a local therapy. It can only kill cancer cells within the exact area it is delivered. Learn more about various radiation techniques here.

Ablation: There are different types of ablation therapy, including cryoablation and radiofrequency ablation. Cryoablation is a procedure that involves the placement of a small probe through the skin to the site of cancer. The probe is guided during the procedure through imaging, such as computed tomography (CT). The cancer cells are then frozen by forming a small pocket of ice, and then thawing it. This process may be repeated. Similar to cryoablation, radiofrequency ablation involves the use of a small probe inserted into the site of cancer. The physician guides the probe through scans so that the treatment can be contained within the site of cancer, limiting the impact on surrounding tissue. Radio waves flow through the probe to the site of cancer, thereby destroying the cancer cells.

Embolization: Embolization refers to a procedure in which the blood supply to the tumor is blocked surgically or mechanically, depriving the tumor of nutrients from the blood. Chemoembolization involves embolization as well as directly administering chemotherapy into a tumor permitting a higher concentration of the drug to be in contact with the tumor for a longer period of time.  Selective Internal Radiation Therapy (SIRT), also known as radioembolization, delivers doses of radiation directly to the site of tumors. During the minimally invasive treatment, millions of radioactive SIR-Spheres microspheres are infused via a catheter into the cancer where they selectively target tumors with a dose of internal radiation up to 40 times higher than conventional radiotherapy, while sparing healthy tissue.

References

1 Demetri G, von Mehren M, Jones R, et al. Efficacy and Safety of Trabectedin or Dacarbazine for Metastatic Liposarcoma or Leiomyosarcoma After Failure of Conventional Chemotherapy: Results of a Phase III Randomized Multicenter Clinical Trial. Journal of Clinical Oncology. 2015.62.4734.
2 United States Food and Drug Administration. FDA approves first drug to show survival benefit in liposarcoma. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm483714.htm. Accessed January 28, 2016.
3 FDA approves Votrient for advanced soft tissue sarcoma [FDA News Release]. U.S. Food and Drug Administration website. Available at:http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm302065.htm