The role of chemotherapy in advanced solitary fibrous tumors: a retrospective analysis

Min S Park, Vinod Ravi, Anthony Conley, Shreyaskumar R Patel, Jonathan C Trent, Dina C Lev, Alexander J Lazar, Wei-Lien Wang, Robert S Benjamin, Dejka M Araujo, Min S Park, Vinod Ravi, Anthony Conley, Shreyaskumar R Patel, Jonathan C Trent, Dina C Lev, Alexander J Lazar, Wei-Lien Wang, Robert S Benjamin, Dejka M Araujo

Abstract

Background: Patients with advanced solitary fibrous tumors (SFTs) have a poor prognosis; treatment options for recurrent disease are particularly limited. Several novel targeted agents have recently shown promise against advanced SFTs, but the relative efficacy of new agents is difficult to assess because data on the efficacy of conventional chemotherapy for SFTs are limited. We thus sought to estimate the efficacy of conventional chemotherapy for SFTs by reviewing data on tumor response to therapy and progression-free survival from SFT patients who received this therapy.

Methods: We retrospectively analyzed the clinical outcomes of 21 patients with grossly measurable, advanced SFTs (unresectable metastatic disease or potentially resectable primary tumors) who received conventional chemotherapy and follow-up at The University of Texas MD Anderson Cancer Center between January 1994 and June 2007. Best tumor response to therapy was assessed using the Response Evaluation Criteria In Solid Tumors 1.1. The Kaplan-Meier method was used to estimate median progression-free survival (PFS) duration.

Results: Of 21 patients, 4 received more than 1 regimen of chemotherapy, for a total of 25 treatments. Doxorubicin-based chemotherapy was given in 15 cases (60%), gemcitabine-based therapy in 5 cases (20%), and paclitaxel in 5 cases (20%). First-line chemotherapy was delivered in 18 cases (72%). No patients had a complete or partial response, 16 (89%) had stable disease, and 2 (11%) had disease progression. Five patients (28%) maintained stable disease for at least 6 months after first-line treatment. The median PFS duration was 4.6 months. The median overall survival from diagnosis was 10.3 years.

Conclusion: Conventional chemotherapy is effective in controlling or stabilizing locally advanced and metastatic SFTs. Our findings can serve as a reference for tumor response and clinical outcomes in the assessment of novel treatments for SFTs.

Figures

Figure 1
Figure 1
Kaplan-Meier curves for progression-free survival duration (PFS) in patients with advanced solitary fibrous tumors who were treated with first-line conventional chemotherapy. Y-axis represents the proportion of living patients without disease progression.
Figure 2
Figure 2
Kaplan-Meier curves for progression-free survival duration (PFS) in patients with advanced solitary fibrous tumors who were treated with conventional chemotherapy (all lines of chemotherapy combined). Y-axis represents the proportion of living patients without disease progression.
Figure 3
Figure 3
Kaplan-Meier curves for overall survival duration (OS) from the time of diagnosis in patients with advanced solitary fibrous tumors who were treated with conventional chemotherapy. Y-axis represents the proportion of living patients.
Figure 4
Figure 4
Kaplan-Meier curves for overall survival duration (OS) from the initiation of chemotherapy in patients with advanced solitary fibrous tumor. Y-axis represents the proportion of living patients.

References

    1. Fletcher CD. The evolving classification of soft tissue tumours: an update based on the new WHO classification. Histopathology. 2006;48(1):3–12. doi: 10.1111/j.1365-2559.2005.02284.x.
    1. Gengler C, Guillou L. Solitary fibrous tumour and haemangiopericytoma: evolution of a concept. Histopathology. 2006;48(1):63–74. doi: 10.1111/j.1365-2559.2005.02290.x.
    1. Enzinger FM, Smith BH. Hemangiopericytoma: an analysis of 106 cases. Hum Pathol. 1976;7(1):61–82. doi: 10.1016/S0046-8177(76)80006-8.
    1. Mena H, Ribas JL, Pezeshkpour GH, Cowan DN, Parisi JE. Hemangiopericytoma of the central nervous system: a review of 94 cases. Hum Pathol. 1991;22(1):84–91. doi: 10.1016/0046-8177(91)90067-Y.
    1. Hasegawa T, Matsuno Y, Shimoda T, Hasegawa F, Sano T, Hirohashi S. Extrathoracic solitary fibrous tumors: their histological variability and potentially aggressive behavior. Hum Pathol. 1999;30(12):1464–1473. doi: 10.1016/S0046-8177(99)90169-7.
    1. Spitz FR, Bouvet M, Pisters PW, Pollock RE, Feig BW. Hemangiopericytoma: a 20-year single-institution experience. Ann Surg Oncol. 1998;5(4):350–355. doi: 10.1007/BF02303499.
    1. Espat NJ, Lewis JJ, Leung D. Conventional hemangiopericytoma: modern analysis of outcome. Cancer. 2002;95(8):1746–1751. doi: 10.1002/cncr.10867.
    1. Magdeleinat P, Alifano M, Petino A, Le Rochais JP, Dulmet E, Galateau F, Icard P, Regnard JF. Solitary fibrous tumors of the pleura: clinical characteristics, surgical treatment, and outcome. Eur J Cardiothorac Surg. 2002;21(6):1087–1093. doi: 10.1016/S1010-7940(02)00099-4.
    1. Harrison-Phipps KM, Nichols FC, Schleck CD, Deschamps C, Cassivi SD, Schipper PH, Allen MS, Wigle DA, Pairolero PC. Solitary fibrous tumors of the pleura: results of surgical treatment and long-term prognosis. J Thorac Cardiovasc Surg. 2009;138(1):19–25. doi: 10.1016/j.jtcvs.2009.01.026.
    1. Park MS, Araujo DM. New insights into the hemangiopericytoma/solitary fibrous tumor spectrum of tumors. Curr Opin Oncol. 2009;21(4):327–331. doi: 10.1097/CCO.0b013e32832c9532.
    1. Park MS, Patel SR, Ludwig JA, Trent JC, Conrad CA, Lazar AJ, Wang WL, Boonsirikamchai P, Choi H, Wang X, Benjamin RS, Araujo DM. Activity of temozolomide and bevacizumab in the treatment of locally advanced, recurrent, and metastatic hemangiopericytoma and malignant solitary fibrous tumor. Cancer. 2011;117(21):4939–4947. doi: 10.1002/cncr.26098.
    1. Stacchiotti S, Negri T, Palassini E, Conca E, Gronchi A, Morosi C, Messina A, Pastorino U, Pierotti MA, Casali PG, Pilotti S. Sunitinib malate and figitumumab in solitary fibrous tumor: patterns and molecular bases of tumor response. Mol Cancer Ther. 2010;9(5):1286–1297. doi: 10.1158/1535-7163.MCT-09-1205.
    1. Ryan CW, von Mehren M, Rankin C, Goldblum JR, Demetri GD, Bramwell V, Ryan CW, Borden E. Phase II Southwest Oncology Group-directed intergroup trial (S0505) of sorafenib in advanced soft tissue sarcomas [abstract] J Clin Oncol. 2008;26:s10532.
    1. Domont J, Massard C, Lassau N, Armand JP, Le Cesne A, Soria JC. Hemangiopericytoma and antiangiogenic therapy: clinical benefit of antiangiogenic therapy (sorafenib and sunitinib) in relapsed malignant haemangioperyctoma/solitary fibrous tumour. Invest New Drugs. 2010;28(2):199–202. doi: 10.1007/s10637-009-9249-1.
    1. Sleijfer S, Ray-Coquard I, Papai Z, Le Cesne A, Scurr M, Schöffski P, Collin F, Pandite L, Marreaud S, De Brawer A, van Glabbeke M, Verweij J, Blay JY. Pazopanib, a multikinase angiogenesis inhibitor, in patients with relapsed or refractory advanced soft tissue sarcoma: a phase II study from the European organisation for research and treatment of cancer-soft tissue and bone sarcoma group (EORTC study 62043) J Clin Oncol. 2009;27(19):3126–3132. doi: 10.1200/JCO.2008.21.3223.
    1. Quek R, Wang Q, Morgan JA, Shapiro GI, Butrynski JE, Ramaiya N, Huftalen T, Jederlinic N, Manola J, Wagner AJ, Demetri GD, George S. Combination mTOR and IGF-1R inhibition: phase I trial of everolimus and figitumumab in patients with advanced sarcomas and other solid tumors. Clin Cancer Res. 2011;17(4):871–879. doi: 10.1158/1078-0432.CCR-10-2621.
    1. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J. New response evaluation criteria in solid tumours: revised RECIST guidelines (version 1.1) Eur J Cancer. 2009;45(2):228–247. doi: 10.1016/j.ejca.2008.10.026.
    1. Constantinidou A, Jones RL, Scurr M, Al-Muderis O, Judson I. Systemic therapy in solitary fibrous tumour [abstract #39407] Miami, FL; 2009. (Proceedings of the 15th Connective Tissue Oncologic Society Annual Meeting). abstract #39407.
    1. Stacchiotti S, Libertini M, Negri T, Palassini E, Gronchi A, Fatigoni S, Poletti P, Vincenzi B, Dei Tos AP, Mariani L, Pilotti S, Casali PG. Response to chemotherapy of solitary fibrous tumour: A restrospective study. Eur J Cancer. 2013 April 5;pii:S0959-8049(13):00220–00227. doi: 10.1016/j.ejca.2013.03.017.
    1. Choi H, Charnsangavej C, Faria SC, Macapinlac HA, Burgess MA, Patel SR, Chen LL, Podoloff DA, Benjamin RS. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol. 2007;25(13):1753–1759. doi: 10.1200/JCO.2006.07.3049.
    1. Benjamin RS, Choi H, Macapinlac HA, Burgess MA, Patel SR, Chen LL, Podoloff DA, Charnsangavej C. We should desist using RECIST, at least in GIST. J Clin Oncol. 2007;25(13):1760–1764. doi: 10.1200/JCO.2006.07.3411.
    1. Beadle GF, Hillcoat BL. Treatment of advanced malignant hemangiopericytoma with combination adriamycin and DTIC: a report of four cases. J Surg Oncol. 1983;22(3):167–170. doi: 10.1002/jso.2930220306.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir