Advanced Soft Tissue Sarcoma with Brian Van Tine, MD, PhD Case 1

Brian Van Tine, MD, PhD:Our first case involves a 36-year-old Caucasian male. He has an undifferentiated pleomorphic sarcoma that’s deeply seated within his retroperitoneum. It’s about 8 cm, and, unfortunately, it’s unresectable. His ECOG performance status is 0, and he’s referred to a center of excellence for sarcoma. He comes looking to see what the best treatment plan for him would be.

So, a typical patient in this situation, we’re looking at it very carefully. The first question we ask our surgeons is, if we’re able to make this smaller, would it become resectable? The next question becomes what sort of underlying comorbidities do you have? Even if you’re at age 36, there are patients that we’ve found that have surprising heart failure. And so, what is their cardiac status? Do they have diabetes? What are all their other medical problems? We have to begin by putting together a true picture of what this patient actually presents as.

As we build this out, the first question comes from the surgeon, which is, can we actually make an attempt to cure if we can shrink the tumor? And, in this case, I believe we were told no. It was invading through things that you couldn’t resect, and because of that, this is a patient with locally advanced disease that’s nonresectable. So, then we look at him, and he has adequate heart function, he has adequate kidney function, he has no hepatitis C, he has no HIV, and his liver function looks good. We say, “You’re a candidate for doxorubicin-based therapy.” Since we’re not going to make an attempt to cure, the use of ifosfamide in this situation may add a lot of toxicity without a lot of long-term benefit. I think we would opt for giving this patient adriamycin with olaratumab, given the overall survival benefit over just giving doxorubicin alone.

Prior to the FDA approval of olaratumab, the approach to this patient would have been palliative chemotherapy, likely doxorubicin-based, as a frontline therapy, then other lines of therapy, subsequently. Now that we have olaratumab and we have access to that, we’ll be adding that to his anthracycline in this case.