OSTEOSARCOMA EVALUATION

1
Shreyaskumar Patel, M.D. Center Medical Director,
Sarcoma Center Professor of Medicine, Deputy
Chairman
Dept. of Sarcoma Medical Oncology
Rational choice of WHICH chemotherapy for Spindle
cell soft-tissue sarcomas
Texas Medical Center Houston, Texas
2
Soft-Tissue Sarcomas 2008 Incidence 10,390 new
cases gt50 different subtypes Lumpers Splitters
3
SOFT-TISSUE SARCOMASCytological
ClassificationPleomorphic / Spindle cell variants
MFH Unclassified Sarcoma Liposarcoma Leiomyosarcom
a Synovial Sarcoma Rhabdomyosarcoma MPNST Angiosar
coma GIST
Desmoid DFSP Hemangioendothelioma Hemangiopericyto
ma / SFT Extraskeletal Chondrosarcoma Extraskeleta
l Osteosarcoma Endometrial Stromal
Sarcoma Mesothelioma Fibrosarcoma
4
SOFT-TISSUE SARCOMASCHEMOTHERAPEUTIC
AGENTSAnthracycline /- Ifosfamide

• MFH / PUS
• Unclassified Sarcoma
• Liposarcoma
• Synovial Sarcoma
• Rhabdomyosarcoma
• Angiosarcoma
• MPNST

5
SOFT-TISSUE SARCOMASCHEMOTHERAPEUTIC
AGENTSGemcitabine /- Taxotere

• Leiomyosarcoma (Gyn and others)
• Angiosarcoma
• Liposarcoma
• MFH
• Unclassified sarcoma
• Synovial sarcoma

6
SOFT-TISSUE SARCOMASCHEMOTHERAPEUTIC
AGENTSTrabectedin

• Leiomyosarcoma
• Liposarcoma
• MFH
• Endometrial stromal sarcoma
• Synovial sarcoma
• Others

7
SOFT-TISSUE SARCOMASCHEMOTHERAPEUTIC
AGENTSMiscellaneous

• DTIC (dacarbazine) for leiomyosarcomas
• Paclitaxel for angiosarcomas
• Topotecan / Irinotecan for rhabdomyosarcomas
• Temodar Avastin for HPC / SFT

8
SOFT-TISSUE SARCOMASPoor sensitivity to
standard therapy

• Fibrosarcoma
• Sarcomatoid mesothelioma (pleural or peritoneal)
• Extraskeletal myxoid chondrosarcoma

9
SOFT-TISSUE SARCOMASCHEMOTHERAPEUTIC
AGENTSHormonal therapy

• Tamoxifen for desmoid tumors
• Megace / AI for ESS
• Hormonal therapy for LMS of gynecologic origin

10
SOFT-TISSUE SARCOMASTargeted therapy

• Desmoids, DFSP - Imatinib
• Hemangioendotheliomas / Angiosarcomas -
  Bevacizumab, Sunitinib, Sorafenib, Pazopanib
• mTOR inhibitors - Deforolimus - ? Non-specific
• Synovial Sarcoma - EGFR inhibitors, DR Agonists
• MPNST - EGFR inhibitors, Raf inhibitors
• Well-diff / Dedifferentiated liposarcoma - CDK
  inhibitors

11
SYSTEMIC THERAPY FOR STSFuture Directions

• Need new agents
• Preferably with an improved therapeutic ratio
• ? Add biologics to chemotherapy
• ? Anti-angiogenic agents, small molecules
• Molecular testing ala Breast Cancer
• Identify patients who need and are likely to
  benefit from systemic therapy

12
Shreyaskumar Patel, M.D. Center Medical Director,
Sarcoma Center Professor of Medicine, Deputy
Chairman
Dept. of Sarcoma Medical Oncology
Rational choice of WHICH chemotherapy for spindle
cell soft-tissue sarcomas
Texas Medical Center Houston, Texas