Results of sub-analysis of a phase 2 study on trabectedin treatment for extraskeletal myxoid chondrosarcoma and mesenchymal chondrosarcoma

Hideo Morioka, Shunji Takahashi, Nobuhito Araki, Hideshi Sugiura, Takafumi Ueda, Mitsuru Takahashi, Tsukasa Yonemoto, Hiroaki Hiraga, Toru Hiruma, Toshiyuki Kunisada, Akihiko Matsumine, Michiro Susa, Robert Nakayama, Kazumasa Nishimoto, Kazutaka Kikuta, Keisuke Horiuchi, Akira Kawai, Hideo Morioka, Shunji Takahashi, Nobuhito Araki, Hideshi Sugiura, Takafumi Ueda, Mitsuru Takahashi, Tsukasa Yonemoto, Hiroaki Hiraga, Toru Hiruma, Toshiyuki Kunisada, Akihiko Matsumine, Michiro Susa, Robert Nakayama, Kazumasa Nishimoto, Kazutaka Kikuta, Keisuke Horiuchi, Akira Kawai

Abstract

Background: Trabectedin is reported to be particularly effective against translocation-related sarcoma. Recently, a randomized phase 2 study in patients with translocation-related sarcomas unresponsive or intolerable to standard chemotherapy was conducted, which showed clinical benefit of trabectedin compared with best supportive care (BSC). Extraskeletal myxoid chondrosarcoma (EMCS) and Mesenchymal chondrosarcoma (MCS) are very rare malignant soft tissue sarcomas, and are associated with translocations resulting in fusion genes. In addition, the previous in vivo data showed that trabectedin affect tumor necrosis and reduction in vascularization in a xenograft model of a human high-grade chondrosarcoma. The aim of the present analysis was to clarify the efficacy of trabectedin for EMCS and MCS subjects in the randomized phase 2 study.

Methods: Five subjects with EMCS and MCS received trabectedin treatment in the randomized phase 2 study. Three MCS subjects were allocated to the BSC group. Objective response and progression-free survival (PFS) were assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 by central radiology imaging review.

Results: The median follow-up time of the randomized phase 2 study was 22.7 months, and one subject with MCS was still receiving trabectedin treatment at the final data cutoff. The median PFS was 12.5 months (95 % CI: 7.4-not reached) in the trabectedin group, while 1.0 months (95 % CI: 0.3-1.0 months) in MCS subjects of the BSC group. The six-month progression-free rate was 100 % in the trabectedin group. One subject with MCS showed partial response, and the others in the trabectedin group showed stable disease. Overall survival of EMCS and MCS subjects was 26.4 months (range, 10.4-26.4 months) in the trabectedin group. At the final data cutoff, two of five subjects were still alive.

Conclusions: This sub-analysis shows that trabectedin is effective for patients with EMCS and MCS compared with BSC. The efficacy results were better than previously reported data of TRS. These facts suggest that trabectedin become an important choice of treatment for patients with advanced EMCS or MCS who failed or were intolerable to standard chemotherapy.

Trial registration: The randomized phase 2 study is registered with the Japan Pharmaceutical Information Center, number JapicCTI-121850 (May 31, 2012).

Keywords: Chemotherapy; Extraskeletal myxoid chondrosarcoma; Mesenchymal chondrosarcoma; Trabectedin; Translocation-related sarcoma.

Figures

Fig. 1
Fig. 1
Kaplan-Meier plot of progression-free survival. Progression-free survival of five patients with EMCS and MCS randomized to the trabectedin group (−) and three patients with MCS randomized to the BSC group (−−−)
Fig. 2
Fig. 2
Clinical course of subject No.2. CT images of target lesions in lung at (a, b) enrollment in the study, (c, d) 4.0 months after enrollment (27 % decrease in sum of diameters), (e, f) 9.2 months after enrollment (50 % increase in sum of diameters). EMCS: Extraskeletal myxoid chondrosarcoma. ▼: Administration of trabectedin. ---: Borderline of 30 % decrease in sum of diameters
Fig. 3
Fig. 3
Clinical course of subject No.3. CT images of target lesion in lung at (a) enrollment in the study, (b) 11.1 months after enrollment (58 % decrease in sum of diameters), (c) 22.5 months after enrollment (46 % increase in sum of diameters). MCS: Mesenchymal chondrosarcoma, VDC: vincristine, doxorubicin and cyclophosphamide, IE: ifosfamide and etoposide. ▼: Administration of trabectedin. ---: Borderline of 30 % decrease in sum of diameters

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